If you are a new physician who has just received your first request for a medicolegal report from an attorney, then it is important for you to respond with a well-formatted, easy-to-read document.
Since your report will be used by legal professionals and possibly a layperson jury, you should take care to use as much non-technical language as possible in your report. Your end-goal is to produce an accurate report for your patient that is easy to read and does not require a medical degree to decipher.
Using bold headings, format your medicolegal report in the following way:
Letterhead and Addresses
Your report must be printed on your practice's letterhead that should include your business address and phone number.
In addition, you need to type the address and phone number of the requesting attorney in the upper left corner.
Date and Salutation
Directly below the attorney's contact information, you should type the date of the report.
Below the date is where you should type your salutation, using this form: "Dear John J Doe, Esq.,"
Introduction and Your Credentials
The first section of your report should simply state the reason for your report. For example, "This report is being generated at the request of John J. Doe, Esq., on behalf of my patient Jane Smith."
Follow this statement with a quick overview of your medical credentials. You should include:
In addition, you should list any professional associations that you are a current member of.
Statement of Documentation Used to Generate the Report
The next section of your report needs to explain to readers how you arrived at your statement of medical findings in the following section of your report.
For example, you should mention that you reviewed:
In addition, you should mention how long you have been treating the patient and any professional observations you have used to determine your diagnosis and treatment plan.
Statement of Your Medical Findings
In this report section, you should clearly explain your medical findings and diagnosis. Take care to use limited medical terminology whenever possible. In this section, you should also explain why you believe your diagnosis and treatment plans to be reliable.
Closing Statement and Your Signature
Following your medical findings, you should close your report with the following, "Sincerely," and your name. Follow your name with your written signature.
By properly wording and formatting your attorney requested medicolegal report, you can provide an accurate document that is able to be easily utilized by the court system. If you have additional questions about how to generate medicolegal reports, you should have a consultation appointment with an attorney who practices personal injury law in your local city or town.
For more information, contact Matthew Steiner MD or a similar medical professional.
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