You are important to us, and I hope we can resolve any issues you have. If there has been a problem or if you are unhappy with the care that you have received in this practice, please contact me to discuss the situation. It has come to my attention that you have been sent several letters regarding your outstanding account with our practice. A medical record release form is enclosed to expedite the process. Upon written authorization, I will provide a copy of your medical record to your new physician. Please contact your health insurance plan or the county medical society for names of other physicians. Your medical condition requires physician supervision, and it is important that you select another physician as soon as possible. This letter is sent to confirm your decision to discontinue care with me. Letter 2 - Confirmation of patient-terminated relationship A medical record release form is enclosed. Upon written authorization, a copy of your medical record will be sent to your new physician. Your medical condition requires continuing physician supervision, and it is important that you select another physician as soon as possible.Ĭontact your health insurance company or the county medical society for the names of other physicians. The termination of our physician/patient relationship will be effective in 30 days from the date of this letter. Please be advised that I will no longer be able to treat you as a patient. Letter 1 - Termination of the physician/patient relationship Check your state guidelines for further definition on sending termination letters electronically. It is preferred to send notification more formally, with physically trackable evidence of delivery. Termination letters should not be sent electronically, such as by email or through the patient portal. A blank authorization to release medical records should be enclosed. Consult your state medical board for guidance. State requirements may dictate specific elements to include in termination letters and how letters should be sent. The letters below are meant as general resources only. The letter should be printed on office letterhead and sent by first-class mail and by certified mail with a return receipt requested. When a physician decides to dismiss a patient, the patient should be notified in writing. See related article Terminating patient relationships: How to dismiss without abandoning Texas Medical Liability Trust Resource Hub
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