Sample Letter From Doctor printable pdf download

Sample Letter From Doctor

Hardship in Immigration Law

July 2014

[SAMPLE LETTER FROM DOCTOR]

** Please print your letter on letterhead, if possible **

[Date]

Honorable Immigration Judge

Executive Office for Immigration Review

[Address]

RE:

[Patient] [and patient’s A-number, if patient is the respondent]

Honorable Judge:

•

Please state your name, position, and how you know [Patient] (e.g. you are his/her

treating physician).

•

Please describe [Patient]’s health condition(s), and be sure to address the following

three points:

Diagnosis

Prescribed treatment

Prognosis

[Note: The following bullet points may not apply to every case. The template should be

personalized based on the facts of your case (e.g. if the patient is the respondent or a family

member, if the patient would be moving to another country or remaining in the U.S., etc.) before

you provide it to the doctor.]

•

To the extent you are familiar, please describe [Patient]’s support network (e.g. who

brings him/her to appointments, who assists with physical or emotional support, etc.)

•

Please describe how you think [Patient]’s condition would be affected if he/she is

deported to [country] (or if he/she accompanies his/her deported family member to

[country]).

•

Please describe how you think [Patient]’s condition would be affected if he/she

remains in the United States but is separated from [respondent].

•

[Etc.]

Sincerely,

[signature]

[your name]

[your title]

Van Der Hout, Brigagliano & Nightingale, LLP

Appendix 5-1

Sample Letter From Doctor