Letter Requests

The Kentucky Physicians Health Foundation is happy to provide letters of compliance or advocacy to third parties on your behalf.

We prepare letters for attorneys, other state licensing boards, credentialing agencies, specialty boards, training programs, legal representatives of the judicial system, other state physicians health programs, third-party payers and malpractice carriers.

These letters include a brief summary of the following items, as applicable to the individual:

  • Initial referral and meeting dates

  • Foundation recommendations

  • Location and dates for evaluations and/or treatment

  • Contract signature date

  • Contract components

  • Contract expiration date

  • Current relationship with the Kentucky Board of Medical Licensure

  • Indication of current compliance or successful completion

Requests to Send Other Information or Documentation

Upon request, the Foundation will provide copies of your contract and/or drug screen testing results. The Foundation WILL NOT forward items provided to our office by third parties. This includes evaluations, discharge summaries and medical records. These items must be obtained directly from the source

Completion of Disability or Unemployment Forms

The Foundation is unable to complete unemployment or disability forms on your behalf. These documents must be completed by your treating physician or treatment facility.

Attesting to Clinical Competency

The Foundation is unable to attest to clinical competency

Instructions to Request a Letter of Advocacy:

Step 1: Complete a Letter Request Form

Please complete all fields and submit. Even letters that are faxed or emailed must be appropriately addressed. Please be aware that letters not addressed to a specific individual are frequently lost and are never received.

Step 2: Make Your Payment:

For delivery via:

     USPS First-Class Mail        $25

     Email                                   $35 

Your request will not be processed until payment has been received in full.

 

 

Step 3: Complete an Authorization for Release of Information

Once you have submitted the Letter Request Form and payment, you have two options for submitting an Authorization for Release of Information:

     a.   The Foundation will automatically prepare and email a certified Authorization for Release of Information Form for    your signature via DocuSign. The form will be emailed to you at the email address provided on your Letter Request            Form.

     b.   If you do not wish to use this method, you may print and complete the form, providing all information requested.

This form must be witnessed, however, you do not need to have it notarized. Foundation staff cannot witness it for                you. Upon completion, please mail and hand deliver the original, signed and witnessed form to Beth Bell at                          Kentucky Physicians Health Foundation, 9000 Wessex Place, Ste 305, Louisville, KY 40222. We are unable to                    accept faxed or emailed releases.

When Can I Expect My Letter to Arrive?

Expect your request to be processed within seven business days of our receipt of all required documentation and payment. Office closures and staff absences may cause delays. Therefore, it is recommended that you submit your request in a timely manner.

Questions

Contact Beth Bell via email at bethb@kyrecovery.org

 Copyright 2018 Kentucky Physicians Health Foundation

ADDRESS

9000 Wessex Pl, Ste 305

Louisville, KY 40222

Contact us

(502) 425-7761

CALL

Tel: 502-425-7761

Fax: 502-425-6871