This is a dispute of account information on my credit report, (report #)
Please re-investigate (or investigate if you have not previously disputed) the following disputed account on my credit report. (give CA name and acct. #)
Please furnish me with verification that (CA name) is reporting this account from (OC name) for ($ amount) in my name. I require the identification of the reporting party and the date of their verification. Please be advised that this request is being made in accordance with the requirements of the FCRA and FACTA and the reporting privacy rules of the HIPAA and (your State)'s Medical Privacy Act.