[Your Name] [Your Address] [City, State, Zip] [Today’s Date] [Physician's Name] [Physician's Address] [City, State, Zip] Dear Dr. [Physician's Last Name], Re: Notification of Termination of Physician's Care I hope this letter finds you well. I am writing to inform you that after much consideration and consultation with another healthcare professional, I have decided to terminate my care with you as my physician. I appreciate the medical attention you have provided me over the years and value the services you have rendered to maintain my health. However, due to various reasons, I have come to the difficult decision of seeking medical care from another healthcare provider. After thorough research and discussions with my loved ones, I believe it is in my best interest to pursue a new path in managing my healthcare needs. I want to emphasize that this decision is not a reflection of your skills or competence as a physician. I have the utmost respect for your knowledge and expertise in the field. Nonetheless, I believe that by exploring a different healthcare option, I may find treatment plans better suited to my current needs. To ensure continuity of care during this transition period, I kindly request copies of my medical records to be sent to the new provider's office. This will enable the smooth transfer of information and allow me to receive uninterrupted medical attention. Please inform me of any procedures or paperwork required for this record transfer process. Moreover, I would like to express my sincere gratitude for the care and guidance you have provided me throughout our doctor-patient relationship. You have played a valuable role in my overall well-being, and for that, I am truly thankful. I truly appreciate the time and effort you invested in my healthcare journey. I kindly ask that you forward any pending prescription refills or outstanding laboratory results to my new healthcare provider. Furthermore, I want to ensure that there are no gaps in my medical treatment during this transition. If you have any prescriptions currently being filled, kindly inform me, so I can provide you with the necessary details. I will also contact your office within the next week to schedule the retrieval of my medical records personally. Please let me know the best time to visit your office to complete this administrative task. Lastly, I would like to reiterate that this decision was not made lightly, and my intent is solely to explore other medical avenues. I want to thank you again for your understanding and support during this transition. Should there be any outstanding balances or necessary financial settlements, kindly inform me at your earliest convenience. I will ensure prompt fulfillment of any payment obligations. Thank you for your attention to this matter. I look forward to your cooperation in facilitating a smooth transition of my medical records. I wish you continued success in your practice and the best of health. With warm regards, [Your Name]
Pennsylvania Sample Letter for Termination of Physician's Care - Patient to Physician
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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)
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.
When a physician-patient relationship must be terminated, the physician must carefully document the circumstances in the patient's medical record. This termination note should review the patient's previous medical treatment and the current state of the patient's health.
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.
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.
When you decide to end your relationship with a patient, inform him or her in writing and send the letter by certified mail, with a return receipt requested. If it's possible to describe the reason for the termination in a brief, clear, objective way, do so in the letter.
Physicians are reminded that patients may continue to de-roster themselves by contacting the Service Ontario INFOline at 1-800-267-8097.
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)
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.
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.
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