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

State:
Multi-State
Control #:
US-0237LR
Format:
Word; 
Rich Text
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Description

This form is a sample letter in Word format covering the subject matter of the title of the form.

Dear [Physician's Name], I hope this letter finds you well. I am writing to inform you that I am terminating my physician's care with your practice effective immediately. In the interest of clarity and transparency, I would like to provide you with a detailed explanation for my decision. First and foremost, I want to express my appreciation for the medical care you have provided me thus far. Your knowledge, expertise, and dedication to your profession have been invaluable in maintaining my health, and for that, I am truly grateful. However, after careful consideration and review, I have made the decision to seek medical care elsewhere. While this choice was not easy to make, I believe it is in my best interest to explore other options for several reasons. One of the primary factors influencing my decision is the need for a physician who is easily accessible on short notice. Unfortunately, there have been instances where it was difficult to secure timely appointments with your office, causing me significant inconvenience and unease. Promptness and accessibility are of utmost importance to me, and I believe they should be fundamental aspects of any physician-patient relationship. Additionally, I must address my concerns about the level of communication and engagement in my care. Although I understand that medical professionals have a busy schedule, I have often felt rushed during appointments and that my questions or concerns were not thoroughly addressed. Effective communication is essential for building trust and fostering a collaborative relationship between a physician and patient, and I believe it is crucial for the success of any treatment plan. Another aspect that played a role in my decision is the lack of coordination and follow-up regarding referrals and test results. There have been instances where I had to personally follow up multiple times to obtain these essential pieces of information, causing unnecessary stress and delays in my care. I firmly believe that timely communication and coordination are vital when it comes to ensuring continuity of care and preventing any potential negative health consequences. While I respect your expertise and professionalism, I feel it is necessary to explore alternative healthcare providers who align more closely with my needs and expectations. My decision to terminate our physician-patient relationship is not a reflection of your capabilities as a physician, but rather an acknowledgment that different individuals have different requirements when it comes to their healthcare. I kindly request that you provide me with copies of my medical records, including any relevant test results, diagnostic reports, and treatment plans. As per the laws governing the release of medical records, I understand that there may be a fee associated with this request, and I am prepared to cover any costs involved. Thank you for your understanding and cooperation in this matter. Should you require any further information or have any questions, I can be reached at the contact information provided below. Your prompt attention to this matter would be greatly appreciated. Wishing you continued success in your practice. Sincerely, [Your Name] [Your Address] [City, State, ZIP] [Phone Number] [Email Address]

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How to fill out Indiana Sample Letter For Termination Of Physician's Care - Patient To Physician?

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FAQ

A patient can end the relationship by giving the physician oral or written notification. Physicians should document this notification in the patient's chart. It may be prudent to send the patient an acknowledgment that he or she has terminated the doctor-patient relationship, and then retain a copy of the letter.

Thanks for your good care and concern2026 Your 'manner' put me at ease and helped me gain confidence. Because of you, I am doing very well. You are truly a remarkable doctor and professional that we respect and trust.

How do you end a message to a doctor? Thank you so much for the difference you make in the lives of your patients! Your kindness, sincere caring, and concern make everything better and are a great encouragement. Thank you so very much for taking care of me and being so skilled at what you do.

The typical termination procedure involves consulting with the patient's insurer about your plans, then sending a letter to the patient by certifed mail, with a return receipt requested.

Always address them by their last name unless they gave you permission to use their first name. For example, if their name is Dr. Kevin Smith, you would write Hi, Dr.

Sincerely, (Physicians name and signature) Your licensed provider must complete, sign and date the letter.

Write "Dear Dr." and the doctor's last name on the top line of the letter itself. For example, begin your message with, "Dear Dr. Williams." Use this prefix for those with doctorates, too, unless the person has specifically told you to avoid doing so.

The discharge letter should be marked "personal/confidential" and mailed by certified mail, return receipt requested, to the patient's last known address. File a copy of the letter and the receipt in the patient's medical record. If the letter is returned unclaimed, mail it again.

When you decide to end your relationship with a patient, inform him or her in writing and send the letter by certified mail, with a return receipt requested. If it's possible to describe the reason for the termination in a brief, clear, objective way, do so in the letter.

Even though physicians retain the legal right to dismiss patients in many situations, there are some circumstances when it's not only unadvisable but unethical and, depending on the state where it occurs, illegal and punishable both by law and by censure.

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