Sample Letter Terminating the Physician-Patient Relationship
Source - Texas Medical Liability & Trust (TMLT) - Sample Termination Letters
When the physician decides to dismiss a patient, the patient should be notified in writing. The letter should be printed on office letterhead and sent by first-class mail and by certified mail with a return receipt requested. Physicians can adapt the following sample letter. To view this letter and others from TMLT, click here...
Date Certified receipt # ______________
[patient address] Also sent first-class mail.
Dear [patient name]:
Please be advised that I will no longer be able to treat you as a patient. The termination of our physician/patient relationship will be effective in 30 days from the date of this letter. Your medical condition requires continuing physician supervision, and it is important you select another physician as soon as possible.
Contact your insurance plan or the county medical society for names of other physicians. Upon written authorization, a copy of your medical record will be sent to your new physician. A release form is enclosed.