Patient Termination Letter for Repeated No-Shows
As a professional, your time is valuable. Should a patient miss out on several, exclusively-assigned appointments, then you may have to terminate that patient. You can do so using the free to download and easily customized Patient Termination Letter No Show template.
This document is available in Google Docs, Word, PDF, and Apple Pages format. It is designed to be easily editable, printable, and downloadable for professional medical use.
Template Structure and Policy
To ensure a professional transition, it is important to include specific details regarding the termination of care. Below is a summary of the key information contained in the sample patient termination letter due to non-compliance:
| Feature | Description |
|---|---|
| Reason for Termination | Successive failure to keep several appointments reserved exclusively for the patient. |
| Emergency Care | Physician remains available only on an emergency basis until other health care is arranged. |
| Medical Records | Forwarding of records occurs upon receipt of a signed authorization form. |
Sample Patient Termination Letter No Show
[Sender Complete Address]
[Date]
[Name of Patient]
[Complete Address]
Dear [Name of Patient],
This letter is to inform you that I will no longer be your attending physician as of [Date]. This is primarily due to your successive failure to keep several appointments reserved exclusively for you. I suggest that you find another physician immediately to provide your medical needs. Any delay could jeopardize your health, so I advise you do it as soon as possible.
I will remain available to provide medical services to you, but only on an emergency basis, until you have arranged for another health care in another practice. Enclosed is a medical records release authorization form for your convenience. I will forward a copy of your medical record upon receipt of your signed authorization.
Respectfully,
[Name and Signature]
[Contact Details]