Maricopa Arizona Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• County: Maricopa
• 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: Termination of Physician's Care — Patienphysiciania— - Important Notification [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Today’s 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 formally inform you about my decision to terminate our patient-physician relationship. This decision comes after careful consideration and deliberation on various factors affecting my healthcare needs and preferences. Firstly, I would like to express my deepest appreciation for the care and dedication you have provided over the course of our professional relationship. Your expertise, guidance, and commitment to my well-being have been valuable. However, after thorough evaluation and discussions with other healthcare professionals and loved ones, I have determined that it is in my best interest to seek a new physician who aligns more closely with my evolving healthcare preferences and goals. Although this decision might be disheartening, please know that it is not a reflection of your medical expertise or the quality of care received. Rather, it is a personal choice driven by the need for a fresh perspective and approach. Due to the nature of our patient-physician relationship, it is crucial that the transition to a new healthcare provider is as seamless as possible. I kindly request your assistance in facilitating this process. Therefore, please forward my complete medical records, including any recent test results or relevant information, to my new physician at your earliest convenience. The contact details for my new healthcare provider are as follows: [New Physician's Name] [New Physician's Address] [City, State, ZIP] [Phone Number] To ensure continuity of care during this transition, I authorize you to directly communicate with my new physician if necessary. As privacy and confidentiality are of utmost importance, I trust that my medical records will be handled in accordance with all relevant laws and regulations regarding patient privacy. Additionally, I would like to request a copy of my medical records for personal reference and safekeeping. Please inform me of any associated fees or administrative requirements to obtain these records, and provide me with guidance on the process for retrieval. I understand that medical emergencies may arise even after our patient-physician relationship has terminated. In such cases, I authorize you to disclose any pertinent medical information to any healthcare providers involved in my care to ensure that I receive appropriate treatment promptly. I want to extend my heartfelt gratitude once again for your unwavering commitment to my health. It is my sincere hope that you continue to provide excellent care to your patients going forward. I am deeply grateful for everything you have done for me over the duration of our professional relationship. Please acknowledge receipt of this letter and confirm your cooperation in the transition of my medical records. Should there be any outstanding bills or administrative matters, kindly forward them to me at the address provided above. Thank you for your understanding and prompt attention to this matter. Wishing you continued success in your medical practice. Sincerely, [Your Name] Keywords: Maricopa Arizona, Sample Letter, Termination of Physician's Care, Patient, Physician, healthcare needs, healthcare preferences, medical records, continuity of care, patient-physician relationship, privacy and confidentiality, medical emergencies, medical information, professional relationship, excellent care, unwavering commitment, outstanding bills, administrative matters.

Subject: Termination of Physician's Care — Patienphysiciania— - Important Notification [Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Today’s 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 formally inform you about my decision to terminate our patient-physician relationship. This decision comes after careful consideration and deliberation on various factors affecting my healthcare needs and preferences. Firstly, I would like to express my deepest appreciation for the care and dedication you have provided over the course of our professional relationship. Your expertise, guidance, and commitment to my well-being have been valuable. However, after thorough evaluation and discussions with other healthcare professionals and loved ones, I have determined that it is in my best interest to seek a new physician who aligns more closely with my evolving healthcare preferences and goals. Although this decision might be disheartening, please know that it is not a reflection of your medical expertise or the quality of care received. Rather, it is a personal choice driven by the need for a fresh perspective and approach. Due to the nature of our patient-physician relationship, it is crucial that the transition to a new healthcare provider is as seamless as possible. I kindly request your assistance in facilitating this process. Therefore, please forward my complete medical records, including any recent test results or relevant information, to my new physician at your earliest convenience. The contact details for my new healthcare provider are as follows: [New Physician's Name] [New Physician's Address] [City, State, ZIP] [Phone Number] To ensure continuity of care during this transition, I authorize you to directly communicate with my new physician if necessary. As privacy and confidentiality are of utmost importance, I trust that my medical records will be handled in accordance with all relevant laws and regulations regarding patient privacy. Additionally, I would like to request a copy of my medical records for personal reference and safekeeping. Please inform me of any associated fees or administrative requirements to obtain these records, and provide me with guidance on the process for retrieval. I understand that medical emergencies may arise even after our patient-physician relationship has terminated. In such cases, I authorize you to disclose any pertinent medical information to any healthcare providers involved in my care to ensure that I receive appropriate treatment promptly. I want to extend my heartfelt gratitude once again for your unwavering commitment to my health. It is my sincere hope that you continue to provide excellent care to your patients going forward. I am deeply grateful for everything you have done for me over the duration of our professional relationship. Please acknowledge receipt of this letter and confirm your cooperation in the transition of my medical records. Should there be any outstanding bills or administrative matters, kindly forward them to me at the address provided above. Thank you for your understanding and prompt attention to this matter. Wishing you continued success in your medical practice. Sincerely, [Your Name] Keywords: Maricopa Arizona, Sample Letter, Termination of Physician's Care, Patient, Physician, healthcare needs, healthcare preferences, medical records, continuity of care, patient-physician relationship, privacy and confidentiality, medical emergencies, medical information, professional relationship, excellent care, unwavering commitment, outstanding bills, administrative matters.