SAMPLE
Date
Dear Dr.___________:
We are required to maintain a record of operative infections as part of our QAPI program. Below
you will find a list of patients who you admitted to the center within the last quarter. If in your
judgment, any of the patients developed an infection, complication, or required hospital admission,
please complete the attached form. Otherwise, indicate “No” next to the patient’s name under
“Postoperative Infections/Complications Admissions” and return this page with your signature to
YOUR FACILITY, at your earliest convenience.
Thank you for your cooperation in our ongoing efforts to assure the highest standard of care for our
patients.
Sincerely,