The _______ (Receiver’s Name),
___________ (Name of the Hospital),
___________ (Address)

Date: __/__/____ (Date)

___________ (Name of the patient),
___________ (Address)

Subject: Request for correction in name

Respected Sir/Madam,

I wish to inform you that I reside at ___________ (Address). I underwent for ____________ (Name of the treatment) treatment on __/__/____ (Date) in your hospital i.e. _________ (Hospital Name).

I would most humbly inform you that my patient ID is _______ (Patient ID) and my name as on the invoice is __________ (Name) which is incorrect. I request you to kindly correct the name to _________ (Correct Name). I request you to issue a copy of the invoice with the correct spelling. I am in need of the same for _________ (maintaining personal records/ Medical claim/ any other).

I shall be highly obliged for your kind if this could be done at the earliest.

Thanking You,

Yours Faithfully,
_____________ (Signature),
_____________ (Name),
_____________ (Contact number)

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