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Sample termination letters

Whenthephysiciandecidestodismissapatient,thepatientshouldbenotifiedinwriting.Thelettershouldbeprintedon officeletterheadandsentbyfirst-classmailandbycertifiedmailwithareturnreceiptrequested.Physicianscanadaptthe followingsampleletters. Termination of the physician/patient relationship Date Certifiedreceipt#______________ [patientaddress] Alsosentfirst-classmail. Dear[patientname]: PleasebeadvisedthatIwillnolongerbeabletotreatyouas apatient.Theterminationofourphysician/patientrelationshipwillbeeffectivein30daysfromthedateofthisletter. Yourmedicalconditionrequirescontinuingphysiciansupervision, and it is important you select another physician as soonaspossible. Contact your insurance plan or the county medical society fornamesofotherphysicians.Uponwrittenauthorization,a copyofyourmedicalrecordwillbesenttoyournewphysician.Areleaseformisenclosed. Sincerely, [physicianname] Non-payment notice Date Certifiedreceipt#______________ [patientaddress] Alsosentfirst-classmail. Dear[patientname]: Ithascometomyattentionthatyouhavereceivedseveral lettersregardingyouroutstandingaccount.Iftherehas beenaproblemorifyouareunhappywiththecarethatyou havereceivedinthispractice,pleasecontactmetodiscuss thesituation.Youareimportanttous,andIhopewecan resolveanyissuesyouhave. Mybusinessmanagerisalsoavailabletodiscusspayment ofyouraccountortoimplementpaymentarrangementsif theyareneeded.Shouldwenothearfromyouwithin30 days,Ibelievethatitwouldbemutuallybeneficialtoterminatethephysician/patientrelationshipsothatyoumay locateanewphysician. Ihopethatwewillhearfromyouinthenearfuture Sincerely, [physicianname]

Confirmation of patient-terminated relationship Date Certifiedreceipt#______________ [patientaddress] Alsosentregularmail. Dear[patientname]: Thisletterissenttoconfirmyourdecisiontodiscontinue carewithme.Yourmedicalconditionrequiresphysician supervision,anditisimportantyouselectanotherphysicianassoonaspossible.Iwillbeavailabletoyouuntil[30 daysfromdateofletter]. Pleasecontactyourinsuranceplanorthecountymedical societyfornamesofotherphysicians.Uponwrittenauthorization,Iwillprovideacopyofyourmedicalrecordtoyour newphysician.Areleaseformisenclosedtoexpeditethe process. Sincerely, [physicianname]

Termination for non-payment Date Certifiedreceipt#______________ [patientaddress] Alsosentregularmail. Dear[patientname]: On[date],Isentyoualetterrequestingthatyoucontactthe businessmanagerormeregardinganyproblemsthatmay haveoccurredresultinginnon-paymentofyouraccount. Intheletter,Istatedthatitwouldbenecessarytoterminate ourphysician/patientrelationshipifwedidnothearfrom you. Sincewehavenotheardfromyou,pleasebeadvisedthatI willnolongerbeabletotreatyouasapatient.Theterminationofourrelationshipwillbeeffectivein30daysfromthe dateofthisletter. Areleaseformisenclosedforyourwrittenauthorization. Pleasecontactuswiththenameofyournewphysicianso wemayforwardyourrecordstohisorheroffice.Atthat time,youraccountwillbeclosed. Sincerely, [physicianname]

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Sample termination letters

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Sample termination letters