Example of Patient Dismissal Letter

[Practice Name]

[Practice Address]

[City, State, ZIP Code]

[Date]

[Patient Name]

[Patient Address]

[City, State, ZIP Code]

Dear [Patient Name],

I hope this letter finds you well. It is with a heavy heart that I write to inform you of our decision to terminate our patient-provider relationship effective [Termination Date], which is 30 days from the date of this letter. This decision was not made lightly, and I want to ensure you understand the reasons behind this action and the steps you should take moving forward.

Reason for Dismissal

The primary reason for this dismissal is [provide a clear and specific reason, such as repeated missed appointments, non-compliance with treatment plans, inappropriate behavior, or non-payment of fees]. Despite our best efforts to address these issues and find a solution, we have been unable to resolve them satisfactorily. As a result, we believe it is in the best interest of both parties to end our professional relationship.

Continuity of Care

Your health and well-being are our utmost priority. To ensure there is no interruption in your medical care, we will continue to provide emergency medical services for the next 30 days until [Termination Date]. During this period, we strongly encourage you to find a new healthcare provider.

Assistance in Finding a New Provider

To assist you in this transition, we recommend contacting your insurance company for a list of in-network providers. Additionally, you may consider reaching out to local medical societies or using online directories to find a new healthcare provider. Here are a few suggestions:

[Provider 1 Name]

Address: [Provider 1 Address]
Phone: [Provider 1 Phone Number]
Specialty: [Provider 1 Specialty]

[Provider 2 Name]

Address: [Provider 2 Address]
Phone: [Provider 2 Phone Number]
Specialty: [Provider 2 Specialty]

[Provider 3 Name]

Address: [Provider 3 Address]
Phone: [Provider 3 Phone Number]
Specialty: [Provider 3 Specialty]

Please contact these providers directly to confirm their availability and to schedule an appointment.

Transfer of Medical Records

To ensure a seamless transition of care, we are prepared to transfer your medical records to your new healthcare provider. Please complete the attached medical records release form and return it to our office as soon as possible. You can send it via mail, fax, or deliver it in person. Once we receive the completed form, we will process the transfer promptly.

Mail: [Practice Address]
Fax: [Practice Fax Number]
In Person: [Practice Office Hours]

Emergency Situations

In case of a medical emergency during this transition period, please visit the nearest emergency room or call 911 immediately. For urgent care needs that arise before you have established care with a new provider, you may contact our office, and we will do our best to assist you within the limits of our termination agreement.

Financial Obligations

Please be aware that any outstanding financial obligations to our practice must be settled promptly. You will receive a final statement detailing any balances due. If you have any questions regarding your account, please contact our billing department at [Billing Department Phone Number].

Final Thoughts

This decision was made with careful consideration and with the hope that you will find a new provider who can better meet your needs and expectations. We value the time we have had as your healthcare provider and are committed to making this transition as smooth as possible for you.

If you have any questions or need further assistance during this transition, please do not hesitate to contact our office. We wish you the best in your future healthcare endeavors and hope for your continued health and well-being.

Sincerely,

[Physician Name][Title][Practice Name]

Attachments:

Medical Records Release Form
List of Recommended Providers

By including clear, respectful communication and providing resources to aid in the transition, this letter aims to ensure the patient's health and continuity of care are prioritized despite the termination of the patient-provider relationship.