Since you have a specific format in which the records need to be exported, transferspreadsheet won't work. Normally, this would be done by grouping in a report.
I like the idea of using recordsets and Excel automation using VBA, but it depends on the table designs/structures.
Are the fields "Seq" & "Notes" in a separate table?
EDIT:
The idea being with tables
tblMembers -----> tblVisits ----> tblNotes
you could then do something like
(pseudo code)
Code:
sub ExportCustomRecords
Open a record set named rsMembers that has fields "PKField", "Encounter", "Name", "dob", "admitdate", "dischargedate", "diagdesc", "attending Provider", "Hospital"
rsMembers.MoveLast
(check if records)
rsMembers.MoveFirst
Do until rsMembers.EOF
write the 8 fields to Excel
Next open a record set named rsNotes with fields "FKField", "Seq", "Notes" Where rsNotes.FKField = rsMembers.PKField
(check for records)
Now loop through the recordset, writing the notes
Close rsNotes
rsMembers.MoveNext
Loop
clean up stuff
Exit sub