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

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• Control #: US-0237LR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Subject: [Patient Name] — Termination of Physician's Care [Physician's Name] [Physician's Address] [City, State, ZIP] [Date] Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate our physician-patient relationship effective immediately. After careful consideration and reflection, I have reached the conclusion that it is in my best interest to seek medical care elsewhere. I would like to express my appreciation for the care and attention you have provided me throughout our time together. Your dedication and expertise have played a vital role in my medical journey, and I am grateful for the knowledge and support acquired under your guidance. However, I believe that a change is necessary at this time. My decision is not a reflection of your competence or the quality of care I have received. Rather, I have decided to explore alternative medical options, possibly seeking a specialization more suited to my unique needs or preferences. I firmly believe that as a patient, it is important to proactively seek the best medical care possible for oneself. I kindly request that you take the necessary steps to ensure a smooth transition of my medical records to my new healthcare provider. As per my rights under the Health Insurance Portability and Accountability Act (HIPAA), I understand that you are obligated to maintain the privacy and confidentiality of my medical information. Therefore, I authorize the release of my complete medical records to my new provider as soon as possible. Please provide me with information regarding any necessary paperwork or procedures I need to follow to facilitate this transfer. I would appreciate your assistance in addressing any pending prescriptions, medical equipment, or referral procedures that require your attention. Furthermore, if there are any outstanding medical bills or insurance claims related to my previous visits, kindly inform me so that we can promptly settle any financial obligations. While our professional relationship is coming to an end, I would like to express my ongoing respect and gratitude for your commitment to the well-being of your patients. Please accept my best wishes for the future and know that I will retain a positive impression of the care I received from you and your team. Thank you for understanding my decision and cooperating in this matter. Should there be a need for any clarifications or further communication, please do not hesitate to contact me at the phone number or email address provided below. Sincerely, [Patient Name] [Patient Address] [City, State, ZIP] [Phone Number] [Email Address] Different types of Connecticut Sample Letters for Termination of Physician's Care — Patient to Physician may include: 1. Connecticut Sample Letter for Termination of Physician's Care — Patient to Primary Care Physician 2. Connecticut Sample Letter for Termination of Physician's Care — Patient to Specialist Physician 3. Connecticut Sample Letter for Termination of Physician's Care — Patient to Surgeon 4. Connecticut Sample Letter for Termination of Physician's Care — Patient to Mental HealtPhysiciAnAnAnan. An

Subject: [Patient Name] — Termination of Physician's Care [Physician's Name] [Physician's Address] [City, State, ZIP] [Date] Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate our physician-patient relationship effective immediately. After careful consideration and reflection, I have reached the conclusion that it is in my best interest to seek medical care elsewhere. I would like to express my appreciation for the care and attention you have provided me throughout our time together. Your dedication and expertise have played a vital role in my medical journey, and I am grateful for the knowledge and support acquired under your guidance. However, I believe that a change is necessary at this time. My decision is not a reflection of your competence or the quality of care I have received. Rather, I have decided to explore alternative medical options, possibly seeking a specialization more suited to my unique needs or preferences. I firmly believe that as a patient, it is important to proactively seek the best medical care possible for oneself. I kindly request that you take the necessary steps to ensure a smooth transition of my medical records to my new healthcare provider. As per my rights under the Health Insurance Portability and Accountability Act (HIPAA), I understand that you are obligated to maintain the privacy and confidentiality of my medical information. Therefore, I authorize the release of my complete medical records to my new provider as soon as possible. Please provide me with information regarding any necessary paperwork or procedures I need to follow to facilitate this transfer. I would appreciate your assistance in addressing any pending prescriptions, medical equipment, or referral procedures that require your attention. Furthermore, if there are any outstanding medical bills or insurance claims related to my previous visits, kindly inform me so that we can promptly settle any financial obligations. While our professional relationship is coming to an end, I would like to express my ongoing respect and gratitude for your commitment to the well-being of your patients. Please accept my best wishes for the future and know that I will retain a positive impression of the care I received from you and your team. Thank you for understanding my decision and cooperating in this matter. Should there be a need for any clarifications or further communication, please do not hesitate to contact me at the phone number or email address provided below. Sincerely, [Patient Name] [Patient Address] [City, State, ZIP] [Phone Number] [Email Address] Different types of Connecticut Sample Letters for Termination of Physician's Care — Patient to Physician may include: 1. Connecticut Sample Letter for Termination of Physician's Care — Patient to Primary Care Physician 2. Connecticut Sample Letter for Termination of Physician's Care — Patient to Specialist Physician 3. Connecticut Sample Letter for Termination of Physician's Care — Patient to Surgeon 4. Connecticut Sample Letter for Termination of Physician's Care — Patient to Mental HealtPhysiciAnAnAnan. An