[Your Name] [Your Address] [City, State, ZIP Code] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP Code] Dear Dr. [Physician's Last Name], Subject: Termination of Physician's Care — Patient to Physician I hope this letter finds you well. I am writing to inform you that I have made the difficult decision to terminate our physician-patient relationship and seek care from another healthcare provider. It is important for me to express my concerns and reasons for this decision. Firstly, I would like to thank you for the medical care and attention you have provided me throughout our association. Your expertise, professionalism, and dedication to my well-being have been valuable and commendable. However, after careful consideration and evaluation of my healthcare needs, I believe it is in my best interest to pursue an alternative path for my medical care. The primary reason for this decision is that my health condition has evolved, requiring specialized care beyond the scope of your practice. Suffolk County, where I reside, has renowned healthcare facilities and providers who specialize in my specific medical condition. Unfortunately, as Suffolk does not offer the required expertise within your practice, I believe it is essential to transition to a more suitable healthcare professional. Moreover, I have recently been introduced to a specialist who has exceptional experience and a proven track record in treating patients with my condition. Upon extensive research and consultation with trusted individuals in the medical field, I have concluded that seeking treatment under their care would provide me with the best chance of achieving optimal health outcomes. I understand that transitioning care may raise concerns regarding continuity and medical records transfer. To ensure a smooth transition, I kindly request your assistance in transferring my medical records, including but not limited to my complete medical history, test results, and treatment plans, to the new healthcare provider. I would appreciate it if you could provide me with a list of all medications, prescriptions, or follow-up instructions that I need to be aware of during this transition period. This information will help ensure minimal disruptions to my ongoing medical care and help facilitate a seamless transition to the new provider. Please consider this letter as my formal notification of the termination of our physician-patient relationship. I would be grateful if you could acknowledge receipt of this letter and provide me with further instructions regarding the next steps, such as the process and timeline for medical records transfer. I would like to express my gratitude once again for your care, support, and guidance during my time under your medical supervision. Furthermore, I recognize the efforts you have made towards improving my health, and I truly appreciate your dedication. Thank you for understanding my decision and for your assistance in facilitating the transition process. Should you have any questions or require further information, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address]. Wishing you all the best in your continued medical practice. Sincerely, [Your Name] Keywords: Suffolk New York, sample letter, termination, physician's care, patient, healthcare provider, physician-patient relationship, concerns, medical care, expertise, professionalism, knowledge, healthcare facilities, healthcare professional, specialized care, medical condition, medical records, treatment plans, medications, prescription, follow-up instructions, transition period.
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.