Nebraska 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. [Your Name] [Your Address] [City, State, Zip] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, Zip] Subject: Termination of Physician's Care — Patient to Physician Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to formally terminate our patient-physician relationship effective immediately. After careful consideration, I have made the difficult decision to discontinue receiving medical care from your practice. It is important for me to express my gratitude for the medical attention and care you have provided to me over the years. Your dedication, knowledge, and skills as a physician have been invaluable and greatly appreciated. However, due to personal circumstances and changing healthcare needs, I have decided to seek medical care from a different provider. I would like to assure you that this decision is not a reflection of your ability as a healthcare professional or the quality of care provided by your practice. My decision is solely based on my personal circumstances and the need to explore different treatment options that align more closely with my current health requirements. I kindly request that you prepare my medical records for transfer to my new healthcare provider as soon as possible. If there are any forms or documents that require completion, please let me know, and I will be happy to provide the necessary information for their prompt and efficient processing. Is there a specific process or paperwork that I need to follow to ensure the seamless transfer of my medical records? If so, please provide instructions, and I will ensure compliance with any applicable requirements. Additionally, I appreciate your assistance in ensuring that any ongoing prescriptions are duly transferred to my new healthcare provider or appropriately managed during this transitional period to avoid any disruptions in my treatment plan. I genuinely value the relationship we have established over the course of my treatment, and the professional rapport we have developed is greatly appreciated. I am confident that you will continue to provide outstanding healthcare services to other patients. Thank you again for your understanding and cooperation in this matter. I wish you continued success in your medical practice. Sincerely, [Your Name]

[Your Name] [Your Address] [City, State, Zip] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, Zip] Subject: Termination of Physician's Care — Patient to Physician Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to formally terminate our patient-physician relationship effective immediately. After careful consideration, I have made the difficult decision to discontinue receiving medical care from your practice. It is important for me to express my gratitude for the medical attention and care you have provided to me over the years. Your dedication, knowledge, and skills as a physician have been invaluable and greatly appreciated. However, due to personal circumstances and changing healthcare needs, I have decided to seek medical care from a different provider. I would like to assure you that this decision is not a reflection of your ability as a healthcare professional or the quality of care provided by your practice. My decision is solely based on my personal circumstances and the need to explore different treatment options that align more closely with my current health requirements. I kindly request that you prepare my medical records for transfer to my new healthcare provider as soon as possible. If there are any forms or documents that require completion, please let me know, and I will be happy to provide the necessary information for their prompt and efficient processing. Is there a specific process or paperwork that I need to follow to ensure the seamless transfer of my medical records? If so, please provide instructions, and I will ensure compliance with any applicable requirements. Additionally, I appreciate your assistance in ensuring that any ongoing prescriptions are duly transferred to my new healthcare provider or appropriately managed during this transitional period to avoid any disruptions in my treatment plan. I genuinely value the relationship we have established over the course of my treatment, and the professional rapport we have developed is greatly appreciated. I am confident that you will continue to provide outstanding healthcare services to other patients. Thank you again for your understanding and cooperation in this matter. I wish you continued success in your medical practice. Sincerely, [Your Name]