Los Angeles California Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• County: Los Angeles
• 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] Dear Dr. [Physician's Last 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. It is with careful consideration and after weighing various factors that I have arrived at this conclusion. Please consider this letter as formal notice of my decision. The purpose of this letter is to explain the reasons for my decision. Firstly, I would like to express my gratitude for the medical care you have provided to me in the past. I appreciate the dedication and professionalism you have consistently demonstrated throughout our relationship. However, after careful evaluation of my medical needs and personal preferences, I have decided to seek care from another healthcare provider. One of the main factors contributing to my decision is my relocation to another city. As you may be aware, I have recently moved to [New City], which is located outside the immediate vicinity of Los Angeles. Consequently, it is no longer convenient for me to continue receiving medical care from your practice. I have found a new physician closer to my current residence who can accommodate my healthcare needs effectively. Additionally, I have recently experienced a change in my health insurance coverage. Due to these changes, I am compelled to choose a healthcare provider within my new insurance network. Unfortunately, your practice is not part of this network, which further necessitated my decision to seek care from a different physician. Please note that my decision is not indicative of any dissatisfaction with the level of care or your competency as a physician. On the contrary, I have always appreciated your expertise and the compassionate care you have provided to me. However, based on my current circumstances, it is in my best interest to transition to a new physician who can better accommodate my needs. I kindly request that you transfer my medical records, including my complete medical history, to my new physician, Dr. [New Physician's Last Name]. To ensure a smooth transition of care, I have already authorized the release of my medical records to Dr. [New Physician's Last Name]. Therefore, I kindly ask that you coordinate the transfer of my medical records with their office. Please provide me with any necessary paperwork or instructions to facilitate this process. I understand that there may be outstanding matters such as open appointments, referrals, or pending test results. Please let me know how I can assist in resolving these matters, whether it be scheduling a final appointment or ensuring a seamless handover to my new physician. I am committed to ensuring a smooth transition and would appreciate your guidance in this regard. Thank you for your understanding and cooperation in this matter. I am grateful for the care you have provided during our time together. Please be assured that my decision to change physicians is based on my personal circumstances and does not reflect negatively on your medical expertise or the care you have provided. Wishing 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] Dear Dr. [Physician's Last 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. It is with careful consideration and after weighing various factors that I have arrived at this conclusion. Please consider this letter as formal notice of my decision. The purpose of this letter is to explain the reasons for my decision. Firstly, I would like to express my gratitude for the medical care you have provided to me in the past. I appreciate the dedication and professionalism you have consistently demonstrated throughout our relationship. However, after careful evaluation of my medical needs and personal preferences, I have decided to seek care from another healthcare provider. One of the main factors contributing to my decision is my relocation to another city. As you may be aware, I have recently moved to [New City], which is located outside the immediate vicinity of Los Angeles. Consequently, it is no longer convenient for me to continue receiving medical care from your practice. I have found a new physician closer to my current residence who can accommodate my healthcare needs effectively. Additionally, I have recently experienced a change in my health insurance coverage. Due to these changes, I am compelled to choose a healthcare provider within my new insurance network. Unfortunately, your practice is not part of this network, which further necessitated my decision to seek care from a different physician. Please note that my decision is not indicative of any dissatisfaction with the level of care or your competency as a physician. On the contrary, I have always appreciated your expertise and the compassionate care you have provided to me. However, based on my current circumstances, it is in my best interest to transition to a new physician who can better accommodate my needs. I kindly request that you transfer my medical records, including my complete medical history, to my new physician, Dr. [New Physician's Last Name]. To ensure a smooth transition of care, I have already authorized the release of my medical records to Dr. [New Physician's Last Name]. Therefore, I kindly ask that you coordinate the transfer of my medical records with their office. Please provide me with any necessary paperwork or instructions to facilitate this process. I understand that there may be outstanding matters such as open appointments, referrals, or pending test results. Please let me know how I can assist in resolving these matters, whether it be scheduling a final appointment or ensuring a seamless handover to my new physician. I am committed to ensuring a smooth transition and would appreciate your guidance in this regard. Thank you for your understanding and cooperation in this matter. I am grateful for the care you have provided during our time together. Please be assured that my decision to change physicians is based on my personal circumstances and does not reflect negatively on your medical expertise or the care you have provided. Wishing you continued success in your medical practice. Sincerely, [Your Name]