Title: Comprehensive Overview of Salt Lake City, Utah: Sample Letter for Termination of Physician's Care — Patient to Physician Introduction: Salt Lake City, Utah is a vibrant and picturesque city nestled at the base of the towering Wasatch Mountains. Renowned for its stunning landscapes, thriving arts scene, and diverse population, Salt Lake City offers its residents a high quality of life. The following is a sample letter for a patient to terminate their physician's care, a crucial document that enables patients to exercise their right to choose their healthcare provider. [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Practice Name] [Practice Address] [City, State, ZIP] Subject: Termination of Physician's Care — [Your Name] Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to officially terminate the physician-patient relationship between us. After careful consideration, I have decided to seek medical care from another healthcare provider. I would like to express my sincere gratitude for your diligent care, expertise, and support during the time I have been under your medical supervision. As a patient, I have always felt respected and heard during our interactions. Particularly, your commitment to providing high-quality healthcare services and your attentiveness to my individual needs have been greatly appreciated. However, after thorough research and consideration of my personal healthcare requirements, I have decided that a change in medical providers is necessary. As a patient, I believe it is important to explore different healthcare options periodically, ensuring that I receive the best possible care tailored to my evolving needs. Please consider this letter an official termination of our physician-patient relationship effective immediately. I kindly request you to transfer all of my medical records, including test results, medications, treatment plans, and other relevant documents, to my new healthcare provider listed below: [New Physician's Name] [New Physician's Practice Name] [Practice Address] [City, State, ZIP] [Phone Number] Additionally, please provide written confirmation of this termination and the date on which my medical records will be transferred, as required by law. I understand that there may be a fee associated with copying and transferring medical records. Kindly inform me of any such charges and the preferred mode of payment. I sincerely appreciate the medical care and support provided by you and your team over the course of our physician-patient relationship. Your professionalism, knowledge, and dedication to patient care have made a lasting impact on me. Thank you for your understanding and prompt attention to this matter. I will be contacting your office in the coming days to ensure that my medical records are transferred accordingly. I wish you continued success in your medical practice. Yours sincerely, [Your Name] Types of Salt Lake City, Utah Sample Letters for Termination of Physician's Care: 1. Sample Letter for Termination of Physician's Care — Patient to Physician (General): This type of letter is used when a patient wants to terminate their physician's care for various reasons, such as relocating, insurance changes, or preference for a different healthcare provider. 2. Sample Letter for Termination of Physician's Care — Patient to Physician (Specific Reason): This type of letter is used when a patient has a specific reason for terminating their physician's care, such as a perceived lack of communication, unsatisfactory treatment outcomes, or negative experiences with the physician. 3. Sample Letter for Termination of Physician's Care — Patient to Physician (Referral): This type of letter is used when a patient wants to terminate their current physician's care in order to pursue treatment from a specific healthcare provider referred by another trusted source, such as a family member, friend, or another physician. Remember to tailor the content of the letter to your specific situation, ensuring that it remains concise, respectful, and clear in conveying your intention to terminate the physician-patient relationship.
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.