Montgomery Maryland Sample Letter for Termination of Physician's Care - Patient to Physician

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• County: Montgomery
• 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] Subject: Termination of Physician's Care Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to formally terminate my medical care under your practice at [Medical Facility Name]. After careful consideration and exploring other options, I have decided to seek medical assistance elsewhere. I would like to express my sincerest gratitude for the medical care you have provided me during our time together. I appreciate the dedication, expertise, and support you have consistently demonstrated. Your professionalism and commitment to patient care have not gone unnoticed. However, certain factors have led me to make this difficult decision. [Here, you can mention any reasons for your decision, such as wanting a second opinion, relocating to a different area, or desiring a specialist's care for a specific condition.] I have already found a new physician who better aligns with my current healthcare needs and goals. Effective immediately, I kindly request that you transfer my medical records to the following healthcare provider: [New Physician's Name] [New Physician's Address] [City, State, Zip] I understand that my medical records are confidential and protected under HIPAA regulations. Therefore, I authorize the release of my medical records to [New Physician's Name] to ensure the continuity of my care. Please send a copy of my complete medical records, including laboratory test results, imaging reports, and any other pertinent documents. Additionally, if there are any outstanding bills or paperwork requiring my attention, kindly inform me so that I can settle any outstanding matters promptly. I would also appreciate it if you could inform me of any ongoing prescriptions or recommendations to facilitate a smooth transition to my new healthcare provider. I would like to thank you again for your care and understanding throughout our physician-patient relationship. Your expertise and compassion have been invaluable to me. I wish you continued success in your medical practice. If you have any further questions or require any additional information, kindly contact me at [Phone Number] or [Email Address]. Thank you for your attention to this matter. Sincerely, [Your Full Name]

[Your Name] [Your Address] [City, State, Zip] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, Zip] Subject: Termination of Physician's Care Dear Dr. [Physician's Last Name], I hope this letter finds you well. I am writing to formally terminate my medical care under your practice at [Medical Facility Name]. After careful consideration and exploring other options, I have decided to seek medical assistance elsewhere. I would like to express my sincerest gratitude for the medical care you have provided me during our time together. I appreciate the dedication, expertise, and support you have consistently demonstrated. Your professionalism and commitment to patient care have not gone unnoticed. However, certain factors have led me to make this difficult decision. [Here, you can mention any reasons for your decision, such as wanting a second opinion, relocating to a different area, or desiring a specialist's care for a specific condition.] I have already found a new physician who better aligns with my current healthcare needs and goals. Effective immediately, I kindly request that you transfer my medical records to the following healthcare provider: [New Physician's Name] [New Physician's Address] [City, State, Zip] I understand that my medical records are confidential and protected under HIPAA regulations. Therefore, I authorize the release of my medical records to [New Physician's Name] to ensure the continuity of my care. Please send a copy of my complete medical records, including laboratory test results, imaging reports, and any other pertinent documents. Additionally, if there are any outstanding bills or paperwork requiring my attention, kindly inform me so that I can settle any outstanding matters promptly. I would also appreciate it if you could inform me of any ongoing prescriptions or recommendations to facilitate a smooth transition to my new healthcare provider. I would like to thank you again for your care and understanding throughout our physician-patient relationship. Your expertise and compassion have been invaluable to me. I wish you continued success in your medical practice. If you have any further questions or require any additional information, kindly contact me at [Phone Number] or [Email Address]. Thank you for your attention to this matter. Sincerely, [Your Full Name]