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

• Category: Letters - Nonlegal - Termination
• State: Multi-State
• County: Orange
• 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: Notice of Termination of Physician's Care — Patient to Physician [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP Code] Dear Dr. [Physician's Last Name], I hope this letter finds you in good health. I am writing to inform you that I have decided to terminate our physician-patient relationship effective immediately. After careful consideration and discussing with my family, I have chosen to seek medical care from another healthcare provider. I want to express my gratitude for the medical care and attention you have provided over the years. Your expertise, commitment, and dedication have been appreciated and have contributed greatly to my well-being. However, after discussing my medical needs with my loved ones, we have collectively decided it is in my best interest to pursue an alternate healthcare approach. Please consider this letter as a formal request to obtain copies of my complete medical records, including any diagnostic reports, test results, treatment summaries, medications prescribed, and relevant healthcare documentation. I kindly request that you forward these records to the address provided above within 30 days from the date of this letter. I understand there may be a nominal fee associated with the copying and release of these records, and I am willing to cover these costs upon receipt of an invoice. To ensure a smooth transition of care, I have already selected a new healthcare provider who will be taking over my medical management. If you deem it necessary, I am open to providing a signed release of information allowing my new physician to consult with you regarding my medical history and ongoing treatment. Please let me know if you require such an authorization. I trust that you will respect my decision and ensure the confidentiality of my medical records as required by the Health Insurance Portability and Accountability Act (HIPAA). If any additional information or signatures are needed to facilitate this process, please do not hesitate to notify me promptly. Thank you again for your medical expertise and services thus far. I genuinely appreciate the care you have provided and wish you continued success in your practice. Sincerely, [Your Name] Keywords: Orange, California, sample letter, termination, physician's care, patient to physician

Subject: Notice of Termination of Physician's Care — Patient to Physician [Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Physician's Name] [Physician's Address] [City, State, ZIP Code] Dear Dr. [Physician's Last Name], I hope this letter finds you in good health. I am writing to inform you that I have decided to terminate our physician-patient relationship effective immediately. After careful consideration and discussing with my family, I have chosen to seek medical care from another healthcare provider. I want to express my gratitude for the medical care and attention you have provided over the years. Your expertise, commitment, and dedication have been appreciated and have contributed greatly to my well-being. However, after discussing my medical needs with my loved ones, we have collectively decided it is in my best interest to pursue an alternate healthcare approach. Please consider this letter as a formal request to obtain copies of my complete medical records, including any diagnostic reports, test results, treatment summaries, medications prescribed, and relevant healthcare documentation. I kindly request that you forward these records to the address provided above within 30 days from the date of this letter. I understand there may be a nominal fee associated with the copying and release of these records, and I am willing to cover these costs upon receipt of an invoice. To ensure a smooth transition of care, I have already selected a new healthcare provider who will be taking over my medical management. If you deem it necessary, I am open to providing a signed release of information allowing my new physician to consult with you regarding my medical history and ongoing treatment. Please let me know if you require such an authorization. I trust that you will respect my decision and ensure the confidentiality of my medical records as required by the Health Insurance Portability and Accountability Act (HIPAA). If any additional information or signatures are needed to facilitate this process, please do not hesitate to notify me promptly. Thank you again for your medical expertise and services thus far. I genuinely appreciate the care you have provided and wish you continued success in your practice. Sincerely, [Your Name] Keywords: Orange, California, sample letter, termination, physician's care, patient to physician