Medical Summary Letter Example for ICAP Membership

The following is an example letter of what providers can write for their patients as verification for the ICAP's program, without specifics. This sample letter is for the Intentional Cannabis Assistance Program For Cancer Patients & Survivors Only.


[Provider's Letterhead]


To Whom It May Concern,

I am writing to confirm that [Applicant's Full Name] is under my care and has been diagnosed with a medical condition. [He/She] is currently receiving treatment for this condition at [Name of Treatment Facility or Healthcare Provider]. [Patient's Full Name] is a valued patient/member of our healthcare program and is an active participant in our efforts to support individuals affected by this medical condition.

[Patient's Full Name] is either undergoing treatment for this medical condition or is a survivor, and their journey is significant for their overall well-being. I believe that [he/she] meets the eligibility criteria based on [his/her] medical condition.

Please do not hesitate to contact me if you require any additional information or clarification regarding [Patient's Full Name]'s medical condition and treatment.



[Provider's Full Name]

[Provider's Title]

[Name of Treatment Facility or Healthcare Provider]

[Contact Information]