[Your Name] [Your Address] [City, State, Zip Code] [Date] [Patient's Name] [Patient's Address] [City, State, Zip Code] Dear [Patient's Name], I hope this letter finds you in good health. I am writing to inform you of the decision to terminate our physician-patient relationship effective [termination date]. This decision was not taken lightly and is based on several factors that have been carefully considered. After reviewing your medical history and conducting a thorough analysis of your case, it is my professional opinion that it would be in your best interest to seek care from another healthcare provider. It is important for you to understand that this termination does not reflect any personal animosity or judgment towards you as an individual. Rather, it is solely based on medical grounds and my belief that an alternative healthcare provider may be better suited to address your unique needs. It is crucial for patients to have a physician who they feel comfortable with and trust wholeheartedly. Throughout our professional relationship, it has become evident that our doctor-patient dynamic has deteriorated significantly, making it difficult to provide the highest level of care that you deserve. Communication barriers, differences in treatment approach, and a lack of mutual understanding have contributed to this strained relationship. I strongly urge you to begin the search for a new healthcare provider promptly to ensure continuous and uninterrupted medical care. To assist you in finding a suitable replacement, I am more than willing to provide a copy of your medical records to your new physician upon receiving a signed release of information form from you. Please note that I will continue to provide emergency medical services to you until the effective termination date stated above. However, non-urgent matters should be directed to your new healthcare provider. Should you require any clarification or assistance during this transition, please do not hesitate to contact my office. It is my ultimate desire to ensure that you receive the best possible care that aligns with your medical needs. Thank you for placing your trust in me during our time together. I sincerely hope that you find a healthcare provider who suits your requirements and can provide you with the exceptional care you deserve. Wishing you good health and a positive future, [Your Name] [Your Title/Designation] [Medical Practice Name (if applicable)]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.