Doctor Patient Termination Letter Sample For Behavior Problems

State:
Multi-State
Control #:
US-0319LR
Format:
Word; 
Rich Text
Instant download

Description

Sample Letter for From Doctor to Patient

How to fill out Sample Letter For From Doctor To Patient?

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FAQ

When the situation for dismissing the patient is appropriate, provide a formal written notice stating that you are withdrawing care and requiring the patient to find another practitioner. Mail the written notice to the patient by both first-class and certified mail with a return receipt requested.

Dear [name], As discussed with you on [date] I regret that I am unable to continue as your treating doctor. I feel it would be in your best interest to transfer your care to an alternative practitioner. I will of course continue to provide ongoing care until you identify your new practitioner.

However, you have been disrespectful to my staff. Such behavior undermines the patient/provider relationship and makes it very difficult to provide your ongoing care. We will gladly send a copy of your records to your new practice at your request. We are sorry that our relationship must end on these terms.

As we discussed, I find it necessary to inform you that I will no longer be able to serve as your doctor as of (date at least 30 days from date of letter). The primary difficulty has been (indicate general reason, e.g., your failure to cooperate with the medical care plan, your behavior toward my staff, etc.).

Dear Patient: The purpose of this letter is to inform you that I can no longer serve as your physician. The reason for this decision is (insert an explanation of the patient's specific actions and the reasons that led up to the decision to end the physician-patient relationship).

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Doctor Patient Termination Letter Sample For Behavior Problems