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

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Multi-State
Control #:
US-0237LR
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Word; 
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This form is a sample letter in Word format covering the subject matter of the title of the form.

Subject: Termination of Physician's Care — Patient to Physician Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you of my decision to terminate my current medical care under your practice. This decision has not been made lightly, and I believe it is in my best interest to seek medical services elsewhere. First and foremost, let me express my gratitude for the care and attention you have provided me during our time together. I appreciate the compassion, expertise, and dedication you have consistently displayed as my healthcare provider. However, due to personal reasons and changes in my medical needs, I have made the difficult decision to pursue medical care from another physician. Living in the bustling city of New York, I am fortunate to have a wide range of healthcare providers and specialists available to me. After careful consideration and discussions with trusted individuals in the medical field, I have chosen to explore alternative options for my ongoing healthcare needs. As per your practice's guidelines, please find below a few details for your reference regarding my transfer of care: 1. Effective Termination Date: [Date, preferably 30 days from the date of this letter] 2. Reason for Termination: As mentioned earlier, I have decided to pursue medical care from another physician due to personal reasons and changes in my medical needs. 3. Request for Medical Records: I kindly request that you transfer my comprehensive medical records to the following physician and address as outlined below: [Physician's Name] [Clinic/Hospital Name] [Street Address] [City, State, ZIP Code] Please ensure the secure and confidential transfer of all pertinent medical information, including test results, treatment plans, and any relevant documentation. 4. Outstanding Appointments or Referrals: If there are any pending appointments, referrals, or consultations with other specialists, please notify me so that I can make the necessary arrangements. I understand that continuity of care is of utmost importance, and I am undertaking this transition with careful consideration. It is essential that my new healthcare provider has access to all relevant medical information to ensure a seamless continuation of my treatment and avoid any potential gaps in care. Lastly, I would like to express my sincere appreciation for the care you have provided me thus far. Your expertise and professionalism are truly commendable, and I am grateful for your dedication throughout my medical journey. Thank you for your understanding and cooperation in this matter. I kindly request a written confirmation of this termination, along with any instructions for obtaining my transferred medical records. Wishing you and your practice continued success, and with warm regards, [Patient's Name] [Patient's Address] [City, State, ZIP Code] [Email Address] [Phone Number] ------ Types of New York Sample Letter for Termination of Physician's Care: 1. New York Sample Letter for Termination of Physician's Care — Emergency Situations: This type of letter can be used if a patient wishes to terminate their physician's care due to an urgent medical situation requiring immediate medical attention elsewhere. 2. New York Sample Letter for Termination of Physician's Care — Relocation: This type of letter can be used if a patient plans to move out of New York and seek medical care from a new healthcare provider in their new location.

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FAQ

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.

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.

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.

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.

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)

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.

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.

A patient can end the relationship by giving the physician oral or written notification. Physicians should document this notification in the patient's chart. It may be prudent to send the patient an acknowledgment that he or she has terminated the doctor-patient relationship, and then retain a copy of the letter.

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)

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