April 21, 2024

Primary Care Physician

Fax Number

I am writing to request medical clearance for one of your patients, [Patient's Name], who is
currently under our care and scheduled for a procedure on [Date]. As part of the pre-procedure
protocol, we need to temporarily discontinue the medication Eliquis (apixaban) for a period of
[number] days prior to the scheduled procedure.
Patient Information:
Name: [Patient's Name]
Date of Birth: [Patient's Date of Birth]
Medical Record Number: [Patient's Medical Record Number]
The decision to temporarily hold off Eliquis is crucial to mitigate potential bleeding risks associated
with the procedure. As the prescribing physician, your approval for the temporary discontinuation
of this medication is essential to ensure the patient's safety and well-being throughout the
perioperative period.
We kindly request your prompt review of the patient's medical history and consideration of the
proposed temporary cessation of Eliquis.
If you have any concerns or require further information regarding the procedure or the patient's
medical condition, please do not hesitate to contact me at 949-867-4004.
Your collaboration in managing the patient's care is highly appreciated, and we value your
expertise in making informed decisions that prioritize the patient's health.

Sincerely,
Marjorie M.
Medical Virtual Assistant
520 Superior Ave. Suite 340
Newport Beach, CA 92663