Why does the thank you note have to identify the patient who was referred? Seems to me if the thank you note said "Our office thanks you for referring a friend to our office," that accomplishes the same purpose, and does not release PHI.
I had an eye doctor once who was referred to me by my aunt. I was apparently not the first person she referred, and he ended up giving her a discount on her next visit for all the business. But I do not think it would have been necessary for him to tell her "Rachel stated she was referred by you; that's the fourth referral you made, here's a 10% discount," but could say "Thank you for the four referrals. To show our appreciation, we are offering you a 10% discount on you next visit."
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