Request Letter to Hospital for Discharge Summary

The Manager,
___________ Hospital (Hospital Name),
___________ (Address)

Subject: Application for Issuance of Discharge Summary of Patient _______ (Patient Name) ________ (Patient ID)

Respected Sir/Madam,

This is to inform you that I ________ (Patient Name) got admitted in your hospital on _______ (dated). I am writing this letter in order to request you to kindly issue discharge certificate as I have to _______ (reason for issuance of discharge summary – mediclaim/ reimbursement / any other reason). I have already paid the bill (copy attached).

I request you to kindly issue the discharge summary at the earliest.

Yours truly,
_______ (Signature)
_______ (Your Name)
_______ (Contact Number)


• Copy of Bill
• ID/Address Proof (If applicable)
• _______ (Any Other Supporting Document – if applicable)

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