Sample Letter
For physicians who are in private practice.
Copy and paste the sample text below to create a letter documenting your level of service (replacing bold text appropriately):

---

Date

National Board of Echocardiography
1500 Sunday Drive, Suite 102
Raleigh, NC 27607

To Whom It May Concern:

RE:	Doctor's Full Name
	Doctor's Date of Birth
	Doctor's Social Security Number

This letter serves to confirm that Dr. ____Name__________is a practicing cardiologist working in private practice. Our records indicate that he/she has performed and interpreted echoes as follows:

	2004	2005	2006
Transthoracic (93303-93308)*	####	####	####
Transesophageal (93312-93317)*	####	####	####
Stress Echo (93350)*	####	####	####

I certify that the numbers of studies provided above are exact numbers and are not rounded and/or estimates.

Sincerely,

Name
Title (President, CEO, or Business Manager)

Sworn and subscribed to before me on

______________________________

______________________________
Notary Public

* NOTE: For the purpose of Certification, a study performed and/or interpreted may be counted only once and must be counted under the code that it was billed. Example: Even though a full TTE is performed as part of a Stress Echo with only a single bill being submitted (93350), the study must be counted as a Stress Echo and cannot be counted as both a TTE and a Stress.

The EXACT number of studies performed and interpreted MUST be provided. Applications containing approximated and/or rounded numbers will NOT be reviewed by the Certification Committee. Letters documenting level of service must be on appropriate letterhead and MUST be notarized.