Arizona Sample Letter for Termination of Physician's Care - Patient to Physician

State:
Multi-State
Control #:
US-0237LR
Format:
Word; 
Rich Text
Instant download

Description

This form is a sample letter in Word format covering the subject matter of the title of the form.

How to fill out Sample Letter For Termination Of Physician's Care - Patient To Physician?

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FAQ

How Can I End the Patient/Physician Relationship? You can end the patient/physician relationship by explicitly telling your doctor that you no longer want to be treated by him or her.

When the situation for dismissing the patient is appropriate, provide a formal written notice stating that you are withdrawing care and requiring the patient to find another practitioner. Mail the written notice to the patient by both first-class and certified mail with a return receipt requested.

The physician terminates the physician-patient relationship by notifying the patient in writing of withdrawal from care after a specific time which is stated in the letter. The patient is also given information necessary to obtain their medical records or transfer to another provider.

This letter is to inform you that I am no longer willing to be your primary care physician. The reason for this decision is describe reason briefly, or omit this sentence. Our office will continue to direct your care for any emergencies that arise over the next 30 days.

The letter can suggest that the patient refer to their managed care organization or respective insurance carrier to obtain the names of physicians who could provide care. If a patient is enrolled in a managed care organization, the managed care organization must also be notified of the termination.

Proper termination requires the following points:Reasonable notice. The length of appropriate notice may depend on the patient's condition and available psychiatric resources in the community.Treatment recommendations and education.Resources for treatment.Records and information.Follow-up letter.

When a physician decides to dismiss a patient, the patient should be notified in writing. The letter should be printed on office letterhead and sent by first-class mail and by certified mail with a return receipt requested.

You can call your doctor, write a note, or let her know at the end of an appointment. Be honest but constructive. If your calls never make it past the receptionist, let her know that. If you need more specialized care, ask for a referral.

In general, the physician-patient relationship can be terminated in two ways without creating liability for abandonment: 1) the physician ends the relationship after giving the patient notice, a reasonable opportunity to find substitute care and the information necessary to obtain the patient's medical records, or 2)

This letter is to advise you that I will no longer be available to provide medical services to you after (FUTURE DATE ALLOWING PATIENT REASONABLE TIME TO FIND ANOTHER PHYSICIAN). I will be available to treat you until (DATE FROM ABOVE), so that you will have access to care while you choose another physician.

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Arizona Sample Letter for Termination of Physician's Care - Patient to Physician