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St. Andrew's Hospital 1256 Main Avenue York, PA 17404 Current Date: 3/24/09 Ms. Eloise Smithers 2101 Market Street York, PA 17404 Dear Ms Smithers: You have been scheduled for surgery next month by the Orthopedic Unit of St Andres Hospital. Within the next few days, you will receive a form that authorizes your physician to provide us with the information on your medical history. This information is vital to us. It will help us to eliminate repeat tests and take into consideration any additional health problems you may have. Please provide the name of your physician to your date of birth on the form. Then sign and date the form and give it to your physician so that your medical history will be forwarded to us before surgery. If you have more than one physician from whom we need records of if you have any questions or concerns, please call us at 717-555-9000 and request additional forms. Sincerely Marcia Walton Administrator fw
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