FROM <<Doctor:Name>>
<<Practice:Name>>
<<Practice:Address>>
Phone: <<Practice:Phone>>
Fax: <<Practice:Fax>>
Email: <<Doctor:E-mail>>
Provider Number: <<Doctor:Provider Number>>

<<Miscellaneous:Date (long)>>

Dear <<Insert name of recipient>>

Case Conference Request

We request your participation in a case conference to discuss the ongoing health care needs of the following patient:

RE: <<Insert Patient Initials>>
DOB: <<Patient Demographics:DOB>>

CASE CONFERENCE DETAILS

Date:	<<Case conference date>>	
Time:		<<Case conference time>>	
Physical location (if applicable):	<<Physical location (if applicable)>>	
Tele or video conference details
(if applicable):	<<Insert Telephone number or video link (if applicable)>>	

Please indicate if you will be participating in this Case Conference:

YES  /  NO

Please reply to: <<Doctor:E-mail>>

Kindest regards

<<Doctor:Name>>