Patient Dismissal Letter Template: A Comprehensive Guide for Healthcare Providers

[Your Practice Letterhead]
[Your Practice Name]
[Your Practice Address]
[City, State, Zip Code]
[Phone Number]
[Email Address]

[Date]

[Patient's Full Name]
[Patient's Address]
[City, State, Zip Code]

Subject: Important Notice Regarding Your Medical Care

Dear [Mr./Ms./Mx. Patient's Last Name],

This letter is to formally inform you of our decision to terminate our professional relationship as your healthcare provider, effective [Date – typically 30 days from the date of the letter].

This decision was made after careful consideration due to [briefly and objectively state the reason, e.g., "a breakdown in the physician-patient relationship," "repeated non-compliance with your agreed-upon treatment plan," "consistent failure to keep scheduled appointments," or "disruptive behavior that compromises the safety and well-being of our staff and other patients"]. We believe that a different healthcare environment may be more conducive to your medical needs and overall well-being.

We understand that this news may be unexpected, and we want to ensure that your medical care continues without interruption. Therefore, we will continue to provide emergency medical care for you until [Effective Date of Termination]. Please note that this provision is strictly for emergencies and does not extend to routine appointments or non-urgent medical needs.

During this transition period, it is imperative that you seek a new healthcare provider to ensure continuity of your medical care. To assist you in this process, we recommend the following:

*   Medical Records: You may obtain a copy of your medical records or have them transferred directly to your new physician. Please complete and sign the enclosed "Authorization for Release of Medical Information" form and return it to our office. Upon receipt of the completed form, your records will be promptly processed and sent to your designated new provider.
*   Finding a New Provider: We encourage you to contact your health insurance company for a list of participating providers in your area. Additionally, you may consult your local medical society or a nearby hospital for physician referral services. You can also search online directories for healthcare providers.

Regarding your current medications, we will provide refills for necessary prescriptions for a period not exceeding [e.g., 30 days] from the date of this letter, to allow you sufficient time to establish care with a new physician. Please contact our office if you require a refill during this notice period.

We wish you the best in finding a new healthcare provider and in your future health endeavors. We are committed to ensuring a smooth transition of your care during this period.

Sincerely,

[Your Name/Physician's Name]
[Your Title/Physician's Title]
[Your Practice Name]

Enclosure: Authorization for Release of Medical Information Form

Important: This letter has been sent via certified mail with return receipt requested for your records and ours.

graph TD
    A[Decision to Dismiss Patient] --> B{Review with Compliance/Legal};
    B --> C[HealOS Regulatory Compliance Agent Verification];
    C --> D[HealOS Clinical Documentation Agent Drafts Dismissal Letter];
    D --> E[Review & Sign Letter];
    E --> F[Send via Certified Mail];
    F --> G[HealOS Patient Data Management Agent Flags Account];
    G --> H[Notice Period Begins (30 Days)];
    H --> I{Emergency Care Needed?};
    I -- Yes --> J[Provide Emergency Care];
    I -- No --> K[Routine Care Denied];
    H --> L{Records Request?};
    L -- Yes --> M[HealOS EHR Interoperability Agent Transfers Records];
    H --> N[Termination Date Reached];
    N --> O[HealOS Patient Data Management Agent Archives File];