Subject: Termination of Physician's Care — Notice of Discontinuation of Medical Services [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 and spirits. After careful evaluation and consideration, I am writing to inform you about the termination of our physician-patient relationship. I understand this news may come as a surprise, but I believe this decision is in the best interest of both parties involved. Please read this letter attentively to understand the circumstances that have led to this unfortunate outcome. As a physician, my primary responsibility is to provide optimal and comprehensive healthcare that meets the needs of my patients. Regrettably, due to [explain reasons such as office closure, relocation, retirement, practice merging, or changes in insurance policies], it is with a heavy heart that I must conclude my professional services at the Philadelphia Pennsylvania Medical Clinic, effective from [termination date — typically 30 days from the date on the letter]. Terminating our relationship does not diminish the care and concern I have for your health and well-being. It is essential that you continue to receive timely medical attention, and I strongly recommend seeking another capable healthcare provider in a timely manner. I would be more than glad to provide a copy of your medical records and any pertinent information to your future physician upon your request. It is important to ensure continuity of care, and your new healthcare provider will require a comprehensive patient history to provide optimal treatment. To obtain a copy of your medical records, please contact our office at [phone number] or [email address] and provide your written consent as it aligns with applicable privacy laws and regulations. Our staff will guide you through the process and ensure your medical records are transferred appropriately. Please note that reasonable administrative fees may apply for the duplication of your records, as permitted by law. I genuinely appreciate the privilege of being your healthcare provider, and I am grateful for the trust and confidence you have placed in me and my team throughout our time together. If there are any questions or concerns during this transition period, please do not hesitate to reach out. I am committed to ensuring a smooth transfer of your medical care and to addressing any potential anxieties you may have. I wish you all the very best in your future healthcare journey and hope you find a new healthcare provider who will meet your needs and provide excellent medical care. Thank you for the opportunity to serve you, and please accept my sincerest apologies for any inconvenience this may cause. Yours sincerely, [Your Name] [Your Title or Specialty] [Contact Information: Phone Number, Email Address]
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.