Fillable Patient Notification Letter Template printable pdf download

DATE

Name field for mail merge

Address field for mail merge

Dear ____________:

We are sending this letter because you had a

name of procedure

Name of Medical Center, Address, City

USA,

between May 21, 2012 and DATE. During this procedure, you were administered a drug produced by

the New England Compounding Center (NECC) that has been recalled. NECC produced an injectable

steroid medication, methylprednisolone acetate, which has been implicated in the multistate outbreak of

fungal meningitis and joint infections. Patients who received implicated lots of methylprednisolone acetate

have already been notified. To date, there have been no confirmed reports of infections linked to other

products produced by NECC. However, out of an abundance of caution, we are contacting patients as we

cannot be sure that other products from this facility were sterile.

Name of Medical

Center, we care about the health and wellness of our patients. We want to know

if you feel unwell. Although we do not know whether the specific drug you received was contaminated, as a

precaution, we want you to know the symptoms of possible infection and urge you to contact your

healthcare provider immediately if you experience any of these symptoms.

You received

medication

that was injected into your

body

site. Symptoms of an infection could include,

[physician should insert information based on body site. For example, if the medication was used in the eye,

symptoms could include vision change, increased redness or

drainage.

Signs and symptoms of meningitis

include fever, headache, stiff neck, nausea and vomiting, photophobia (sensitivity to light) and altered mental

status. Symptoms for other possible infections may include fever; swelling, increasing pain, redness, warmth

at injection site; chest pain, or drainage from the surgical site (infection within the

chest).] If you have any

of these symptoms, you should seek medical care so that you can be properly evaluated.

All of us at

Name of Medical Center

understand that this information is alarming and may be frightening.

We realize that your care at

Name of Medical Center

depends on safe medication. The Food and Drug

Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the state health

department are working to understand if any products, beyond the steroid product known to be associated

with meningitis and joint infections, were contaminated and pose a risk to patients.

Again, at

Name of medical

center, we care about the health and wellness of our patients. Please do not

hesitate to call us about this matter.

If you want to learn more about the investigation of products from NECC, you may also call FDA’s Division

of Drug Information at 855-543-DRUG (3784) and press * to get the most recent information regarding the

mulitistate meningitis outbreak, report an adverse event, or speak directly to a pharmacist. Additional

information is available at

and

Sincerely,

CEO

Name of Medical Center

Patient Notification Letter Template

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