Q:

Hi Dr. Margolies,
I looked through your smart start book for a letter to an Ins. co. or Atty. 
whichever, for a letter stating that I am beginning treatment on one of 
their policy holders or clients. Just wondering if there is a standard form 
for this communication.

A:

Thanks for the e-mail .. below are some ideas. I have some templates on my computer .. I 
just mix and match. Below is what I initially send to the PI insurance carrier and a copy to 
the attorney .. 


Supplemental Information

On July 22, 1998 John Jones entered my office for evaluation of injuries reportedly 
sustained in a auto related collision dated July 16,1998.  At the time of this evaluation, a 
general history and physical examination studies were completed.  Following are the results 
of my findings:

Description of accident: 

Previous History  Non-Contributory 

Diagnosis: A = acute / C = chronic / MI = mild / MO = moderate   

Ä 847.0 (A-MO Sprain/Strain Cervical Injury)
Ä 847.1 (A-MO Thoracic Sprain/Strain Injury)
Ä 847.2 (A-MO Lumbar Sprain/Strain Injury)

	Resulting in:
Ä 723.1 (A-MO Cervicalgia)
Ä 724.1 (A-MO Thoracic Pain)
Ä 724.2  (A-MI-MO Lumbar Pain)
Ä 729.1  (A-MO Paraspinal Myofascitis)
Ä 728.85 (A-MO Paraspinal Muscle Spasms)

Patient was advised of our findings and recommended conservative chiropractic care is 
being provided.

Note: I advised this patient to refrain from work for one week

 ... OR ... this is what I send to the patient's medical doctor if they are in an HMO:


Supplemental Information

May 21, 1999

TO: Dr. Jill Smith

Patient: Frances  Jones       CignaHealthcare       ID# 532413221-01     

Thank you for your kind referral. Dr. Margolies has been in active practice since 1978 and 
presently teaches part time at Life University, School of Chiropractic. Our approach is 
conservative and will assist in your care to date. If there are any questions please do not 
hesitate to call them to my attention. Again, thank you for the privilege of assisting in the 
care of your patient. Below is the initial findings of my evaluation and recommendations 
for your patient¼s chiropractic care.


History: Patient states she has been experincing lower back pain after working in her 
graden. The pain became acute across the beltline for the past few days. 
 
Examination: Patient was in visible acute pain with an flexed antaligic body lean due to 
lower back pain

Impression and Recommendations: Patient reviewed our findings and we discussed 
conservative stretch exercises, use of ice, and specific lifestyle changes to assist in healing. 
The chiropractic approach to care was explained and she asked a number of questions that 
were answered. Conservative and specific „non-force¾ methods of care will be used to 
stabilze and hopefully reduce the degree of pressure bearing on her paraspinal soft tissue 
and contain the disc distress. Due to the nature and mechanics of her structural insult and 
her chronic subjective complaints, a trial period of conservative care is recommended. It is 
hoped that this will assist in further stability and strength to her spine and reduction of her 
complaints.
I appreciate this opportunity to assist your patient  

..OR ..


Enclosed please find my initial supplemental report, as well as other forms that were 
necessary to provide me with a working diagnosis and protocol to assist him. He has 
requested I send claims of services to your attention. 

Please note the Doctor¼s Lien as witness to the patient¼s agreement that upon completion of 
their case, any fees for our professional services will be paid. I would appreciate your 
acknowledgment of same by signing and returning this lien to our office. 

As is customary with our office, we will send final claims when the patient is released from 
active care along with a final report and complete office notes. 

If there are any questions concerning him do not hesitate to call it to my attention.



Hope this helps:

Have a Great Day

Dr. M