New Mexico 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: Notice of Termination of Physician's Care — Patient to Physician [Your Name] [Your Address] [City, State, Zip Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Practice] [Address] [City, State, Zip Code] Dear Dr. [Physician’s Last Name], I hope this letter finds you well. I am writing to notify you of my decision to terminate my care under your medical practice effective [termination date, typically 30 days from the date of this letter]. Over the course of our physician-patient relationship, I have appreciated the care and attention you have provided. However, after careful consideration, I have decided to seek medical treatment elsewhere. While I understand that the continuity of care is important, I firmly believe this decision is in my best interest at this time. I would like to emphasize that my decision is not a reflection of the quality of care I have received from you or your staff. To ensure a smooth transition of care, I kindly request the following steps be taken: 1. Transfer of Medical Records: Please arrange for the transfer of all my medical records, including test results, consultation notes, and any other relevant documents, to the new physician I have chosen. To expedite this process, I have completed the necessary release of information forms for your convenience. Kindly confirm once the records have been transferred. 2. Prescriptions and Refills: As I will be transitioning to a new healthcare provider, please provide me with any necessary prescriptions or refills to ensure I have an adequate supply of medication until I establish care with my new physician. 3. Follow-Up Appointments: If there are any pending follow-up appointments or scheduled procedures, please inform me accordingly, as I will need to make arrangements with my new healthcare provider. 4. Financial Settlement: I kindly request an itemized statement of any outstanding balances or payments due for the services rendered to date. Please provide information regarding the settlement process and inform me of any steps or documentation required. As mentioned earlier, I am thankful for the care you have provided thus far. However, I believe transitioning to a new healthcare provider is the best choice for my current medical needs. Please consider this letter as my formal termination notice, and I trust that you will respect my decision. I sincerely hope for your understanding and cooperation during this transition period. Thank you for your attention to this matter. I wish you and your practice continued success. If you require any further information or have any specific instructions regarding the termination process, please do not hesitate to contact me. Yours sincerely, [Your Name]

Subject: Notice of Termination of Physician's Care — Patient to Physician [Your Name] [Your Address] [City, State, Zip Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Practice] [Address] [City, State, Zip Code] Dear Dr. [Physician’s Last Name], I hope this letter finds you well. I am writing to notify you of my decision to terminate my care under your medical practice effective [termination date, typically 30 days from the date of this letter]. Over the course of our physician-patient relationship, I have appreciated the care and attention you have provided. However, after careful consideration, I have decided to seek medical treatment elsewhere. While I understand that the continuity of care is important, I firmly believe this decision is in my best interest at this time. I would like to emphasize that my decision is not a reflection of the quality of care I have received from you or your staff. To ensure a smooth transition of care, I kindly request the following steps be taken: 1. Transfer of Medical Records: Please arrange for the transfer of all my medical records, including test results, consultation notes, and any other relevant documents, to the new physician I have chosen. To expedite this process, I have completed the necessary release of information forms for your convenience. Kindly confirm once the records have been transferred. 2. Prescriptions and Refills: As I will be transitioning to a new healthcare provider, please provide me with any necessary prescriptions or refills to ensure I have an adequate supply of medication until I establish care with my new physician. 3. Follow-Up Appointments: If there are any pending follow-up appointments or scheduled procedures, please inform me accordingly, as I will need to make arrangements with my new healthcare provider. 4. Financial Settlement: I kindly request an itemized statement of any outstanding balances or payments due for the services rendered to date. Please provide information regarding the settlement process and inform me of any steps or documentation required. As mentioned earlier, I am thankful for the care you have provided thus far. However, I believe transitioning to a new healthcare provider is the best choice for my current medical needs. Please consider this letter as my formal termination notice, and I trust that you will respect my decision. I sincerely hope for your understanding and cooperation during this transition period. Thank you for your attention to this matter. I wish you and your practice continued success. If you require any further information or have any specific instructions regarding the termination process, please do not hesitate to contact me. Yours sincerely, [Your Name]