[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Patient Name] [Patient Address] [City, State, ZIP] Subject: Termination of Physician's Care Dear [Patient Name], I am writing to inform you of my decision to terminate our physician-patient relationship. As a [specialty] physician, I always strive to provide the best care possible to my patients; however, due to unforeseen circumstances, I find it necessary to discontinue our medical association. Before detailing the reasons for this decision, I want to assure you that this termination is not an indication of any personal dissatisfaction towards you as a patient, nor is it a reflection of your character or medical condition. It is essential to maintain clear and open communication between a physician and their patients, and I believe this disclosure is crucial for both parties involved. [Optional — Reason for Termination — - Mention any medical practice changes affecting your availability or geographic location:] With the recent changes in my medical practice, I am transitioning to a different healthcare facility that will require me to devote my attention and expertise exclusively to their patients. Unfortunately, this means that I will no longer be able to continue as your primary care physician at [current medical practice/organization]. [Optional — Reason for Termination — - Mention any personal reasons or considerations affecting your ability to provide care:] Additionally, as much as I value our relationship, I have made the difficult decision to reduce my patient load in order to prioritize my own well-being and achieve a healthier work-life balance. It is essential for me to provide the highest level of care, and by doing so, I need to manage my workload more effectively. This decision has been reached after careful consideration of my own physical and mental health. While I understand that the termination of our relationship may cause inconvenience or concern, it is crucial to ensure a seamless transition of your medical care. To facilitate this process, I have taken the liberty of arranging for your medical records to be conveniently transferred to another qualified physician in the San Jose area. The physician, [Recommended Physician's Name], is highly skilled in [Specialty] and has an excellent reputation within the medical community. [Optional — Recommendation of Specific Physicians or Healthcare Facilities:] In addition to [Recommended Physician's Name], I have compiled a list of other reputable physicians and healthcare facilities in the San Jose area whom you may consider for your ongoing medical care. Please find the attached list, which includes their contact information and specialties. It is advisable to contact your insurance provider for guidance on selecting a physician who participates in your insurance plan. As mandated by professional guidelines, my termination of care will be effective [30/60-day period], starting from the date of this letter. During this time, my office will remain available to assist you with any urgent medical needs, prescription refills, or providing you with necessary medical documentation. In closing, I regret any inconvenience my decision may cause you and want to assure you that your health and well-being remain my utmost priority. I am confident that the transition to a new healthcare provider will be smooth and that you will continue to receive exceptional medical care. If you have any concerns or questions regarding this matter, please do not hesitate to contact me or my staff. Thank you for the trust you have placed in me as your physician, and I wish you continued good health in the future. Yours sincerely, [Your Name] [Your Title/Designation] [Your Medical Practice/Organization]
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.