The ___________ (Manager/HOD),
___________ (Billing/Administration Department),
_____________ (Name of the Hospital),
_____________ (Address)

Date: __ /__ /____ (Date)

______________ (Name of the Attendant),
______________ (Name of the Department),
______________ (Name of the Hospital)

Subject: Request for discount in the treatment bill


I am writing this letter on behalf of the patient named ________ (Name of the patient) admitted on ________ (Date) in the department _________ (Name of the department).

The patient was diagnosed with ___________ (Name of the disease) and is undergoing the treatment _________ (Name of the treatment) for the same. The bill amount estimated for the treatment is ___________ (Amount). I would like to state that the patient is going through a rough patch and it is facing difficulty in paying the complete bill. The patient has a clean history with the tax department and is a responsible citizen with the responsibilities of the family as well.

I request you to please give some amount of discount on the bill number __________ (Mention the patient’s bill number). I am attaching the patient’s file and a copy of the bill for your reference. I hope you will consider my request as genuine and show some kindness.

_____________ (Name),
_____________ (Signature)

Enclosed: Patient’s Chart and Bill

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