Mecklenburg North Carolina Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• County: Mecklenburg
• 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: Terminating Physician's Care — Patient to Physician Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you about my decision to terminate our physician-patient relationship, effective from [date]. This decision has been made after thoughtful consideration and discussion with my family members. We have had a professional relationship for [duration], during which you have provided medical care and treatment for my [specific medical condition or concerns]. I appreciate the efforts and expertise you have demonstrated in managing my health. However, recent changes in my personal circumstances and medical needs have led me to reevaluate the continuity of our physician-patient relationship. [Explain these changes, whether it is a need for specific specialists, relocation, change in insurance coverage, or seeking a second opinion]. As a result, I have decided to seek medical care from a different healthcare provider that aligns better with my current situation. Please be assured that my decision is not a reflection of your competence or the quality of care you have provided. I have valued your professionalism, attention to detail, and your ability to explain complex medical issues in a way that was easy for me to understand. However, due to the aforementioned changes, I believe it is in my best interest to transition my care to a provider who can meet my evolving needs more effectively. I kindly request that you provide me with a copy of my medical records, including any test results, diagnoses, treatment plans, and medication history, as is my right under HIPAA regulations. You may forward the records directly to my new healthcare provider at [new provider's name and address], or if it is more convenient, please inform me of the procedure to collect them from your office. I would like to express my gratitude for the medical care and attention you have provided me throughout our professional relationship. I am genuinely thankful for your dedicated service and sincerely wish you all the best in your future endeavors. Please understand that my decision is final, and I kindly request no further attempts to retain my patronage. I trust you will respect my wishes and facilitate a smooth transition of care. Thank you for your understanding and cooperation in this matter. I look forward to receiving confirmation of receiving this termination letter and the subsequent steps to retrieve my medical records. Kind regards, [Your Name] [Your Contact Information]

Subject: Terminating Physician's Care — Patient to Physician Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you about my decision to terminate our physician-patient relationship, effective from [date]. This decision has been made after thoughtful consideration and discussion with my family members. We have had a professional relationship for [duration], during which you have provided medical care and treatment for my [specific medical condition or concerns]. I appreciate the efforts and expertise you have demonstrated in managing my health. However, recent changes in my personal circumstances and medical needs have led me to reevaluate the continuity of our physician-patient relationship. [Explain these changes, whether it is a need for specific specialists, relocation, change in insurance coverage, or seeking a second opinion]. As a result, I have decided to seek medical care from a different healthcare provider that aligns better with my current situation. Please be assured that my decision is not a reflection of your competence or the quality of care you have provided. I have valued your professionalism, attention to detail, and your ability to explain complex medical issues in a way that was easy for me to understand. However, due to the aforementioned changes, I believe it is in my best interest to transition my care to a provider who can meet my evolving needs more effectively. I kindly request that you provide me with a copy of my medical records, including any test results, diagnoses, treatment plans, and medication history, as is my right under HIPAA regulations. You may forward the records directly to my new healthcare provider at [new provider's name and address], or if it is more convenient, please inform me of the procedure to collect them from your office. I would like to express my gratitude for the medical care and attention you have provided me throughout our professional relationship. I am genuinely thankful for your dedicated service and sincerely wish you all the best in your future endeavors. Please understand that my decision is final, and I kindly request no further attempts to retain my patronage. I trust you will respect my wishes and facilitate a smooth transition of care. Thank you for your understanding and cooperation in this matter. I look forward to receiving confirmation of receiving this termination letter and the subsequent steps to retrieve my medical records. Kind regards, [Your Name] [Your Contact Information]