Download Electric Company Letter (Template)

Template Letter: Electric Company Notification
Return Address Line 1
Return Address Line 2
Date (Month, Day, Year)
Full Name of Recipient
Title/Position/Department of Recipient
Name of Electric Company
Address Line 1
Address Line 2
To Whom It May Concern:
This letter is in regard to one of your customers, whose identifying information appears below, and who has a
life-sustaining device that is dependent on electrical power supply:
Patient Name
Patient Address
Patient City, State Zip
Patient Telephone Number
Account Number
Name of Patient has an implanted “heart pump” or a ventricular assist device (VAD), called the HVAD® System,
manufactured by HeartWare, Inc. The HVAD® System assists a patient's weakened heart to pump blood
throughout his or her body.
Name of Patient is to be discharged home on date following hospitalization for surgical placement of the
HVAD® System. Name of Patient requires access to an electrical source at all times to maintain his life support
equipment. As a result, the electrical service should not be interrupted and any power outages that affect the
home should be considered a critical priority for restoration. It is important that you give special attention to
power lines and equipment repairs in Name of Patient’s area.
If you have any questions regarding the VAD, please feel free to contact us at the implant center listed below.
Additional information on the VAD is also available on the manufacturer’s website: www.heartware.com
Implant Center Name
Implant Center Address Line 1
Implant Center Address Line 2
City, State Zip
Phone Number
Sincerely,
Name of Implanting MD
Phone Number
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GL1093 Rev01 11/14