Traducción para entender la carta. Se envía la carta en inglés.
Solicitud de factura detallada
Solicito una factura detallada para cada una de estas cuentas: Maria Sample, cuenta LDH-45821, servicios del July 14, 2026 al July 16, 2026.
La ley de Florida dice que el hospital debe proporcionarla después del alta cuando se solicite, dentro de 7 días de mi solicitud (Florida Statutes 395.301(1)(e)).
Por favor envíela a la dirección abajo indicada. Gracias.
SAMPLE — FICTIONAL DATA. NOT A REAL LETTER.
October 27, 2026
To: Patient Financial Services, Lakeview Demo Hospital
Request for an itemized statement
Dear Patient Financial Services team,
I am asking for an itemized statement for each of these accounts: Maria Sample, account LDH-45821, services from July 14, 2026 to July 16, 2026.
Florida law says the hospital must provide it after discharge upon request, within 7 days of my request (Florida Statutes 395.301(1)(e)). Florida Statutes 395.301
Please send it to the address below. Thank you.
Sincerely,
Maria Sample
12 Example Lane
Riverton, ST 12345
(555) 010-0199
Signature
Where this comes from (for you, not part of the letter)
- Florida Statutes 395.301, 2026, page 1:
Upon request, and after the patient's discharge or release from a facility, the facility must provide to the patient or to the patient's survivor or legal guardian, as appropriate, an itemized statement or a bill detailing in plain language
- Florida Statutes 395.301, 2026, page 1:
The initial statement or bill shall be provided within 7 days after the patient's discharge or release or after a request for such statement or bill, whichever is later.
Rules: the public Financial Assistance Policy and form of Memorial Regional Hospital (FL; MHS = Memorial Healthcare System), applied to the fictional Lakeview Demo Hospital case.
Not legal or medical advice. You review and sign every letter.