[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP Code] Subject: Notice of Termination of Physician's Care Dear Dr. [Physician's Last Name], I hope this letter finds you well. After careful consideration, I have decided to terminate our physician-patient relationship effective immediately. This decision is not made lightly, but I believe it is in my best interest to seek alternative medical care. As a responsible patient, I understand the importance of open communication and the need to provide you with a detailed explanation for my decision. The reasons for terminating our relationship include: 1. Inadequate Communication: Despite my attempts to engage in meaningful dialogue regarding my healthcare questions and concerns, I have experienced a lack of timely and effective communication. Prompt and thorough communication is essential to foster trust and maintain a strong patient-physician relationship. 2. Quality of Care Concerns: I have noticed a decline in the quality of care provided during my previous visits. Effective healthcare relies on accurate diagnoses, appropriate treatment plans, and timely interventions. I have experienced instances where my health concerns have been dismissed or inadequately addressed. 3. Availability and Accessibility: It has become increasingly difficult to secure timely appointments, reach your office for urgent matters, or receive prompt responses to my inquiries. In order to ensure optimal healthcare outcomes, it is essential to have access to a healthcare provider who is readily available and responsive. 4. Personal Incompatibilities: Our patient-physician relationship requires mutual trust and a compatible working relationship. Unfortunately, I have found our interactions to be strained, hindering effective communication and reducing my confidence in your ability to address my healthcare needs. I would like to request a copy of my medical records, including all test results, consultations, and treatments, as allowed by law. Please inform me of any fees associated with transferring my medical records to my new healthcare provider. You may securely deliver the records to the following address: [Your Preferred Address for Medical Records Delivery] I expect that all my medical records will be transferred within the time frame mandated by Arizona law. Additionally, please specify the process by which I can collect the records or if they will be mailed directly to my new healthcare provider. I appreciate the care you have provided thus far and acknowledge that, at times, it has been beneficial. However, based on the aforementioned reasons, I believe it is in my best interest to pursue a different course of medical care. I trust that you will respect my decision and promptly fulfill my request for the transfer of medical records. Thank you for your attention to this matter. Should you require any additional information or have any questions, please do not hesitate to contact me at the provided contact information. Sincerely, [Your Name]
Arizona Sample Letter for Termination of Physician's Care - Patient to Physician
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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.
