[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Patient's Name] [Patient's Address] [City, State, ZIP] Dear [Patient's Name], RE: Termination of Physician's Care I hope this letter finds you in good health. I am writing to inform you of my decision to terminate our physician-patient relationship, effective [date of termination]. I have carefully evaluated your medical condition and overall progress during the course of our relationship. While providing medical care, it is essential to establish a partnership built on trust, respect, and effective communication between a patient and their physician. Regrettably, despite efforts from both parties, it appears that this foundation has been compromised and does not promote the optimal provision of medical care. After due consideration, I believe it is in both your best interest and mine to transfer your medical care to another healthcare provider. To ensure continuity of care, I recommend that you promptly seek alternative medical assistance. I kindly suggest consulting with your insurance provider or primary care physician to facilitate a smooth transition. In compliance with medical ethics and the applicable laws, I will provide you or your new healthcare professional with a copy of your medical records upon receipt of a written request signed by you. These records include, but are not limited to, medical history, test results, and any relevant treatment plans. Alternatively, you may choose to have your records stored securely in my office for a period of [number of years] from the date of termination, after which they will be appropriately disposed of in accordance with the prevailing regulations. Please be aware that until you have identified a new healthcare provider and transferred your medical care, I will remain available for emergency consultations or for addressing any critical healthcare concern. However, routine medical inquiries or requests should now be directed to your new physician. I understand that this decision may raise questions or concerns. If you would like further clarification or require any assistance with the transition process, please do not hesitate to contact my office, and I will be more than willing to help. I would like to express my gratitude for the opportunity to have served as your physician, and I sincerely hope your future medical journey leads to improved health and well-being. Wishing you all the best in your future endeavors. Sincerely, [Your Name] [Your Title] [Your Medical Practice] [Contact Information] Keywords: termination of physician's care, physician-patient relationship termination, discontinuation of medical care, transfer of medical care, alternative healthcare provider, medical records transfer, continuity of care, medical ethics, healthcare professional, patient's medical records, routine medical inquiries, transition process, emergency consultations, request for clarification.
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.