Free Patient Discharge Format Termination Letter Template
Patient Discharge Format Termination Letter
[Date]
To: [Patient’s Name]
[Patient's Address]
[City, State, Zip Code]
Subject: Discharge/Termination of Services
Dear [Patient's Name],
I hope this letter finds you well. We are writing to inform you that, effective [Date], we are discontinuing the provision of medical services at [Healthcare Facility Name]. After careful consideration, we have determined that this action is in the best interest of both parties.
This decision is based on [reason for discharge or termination – e.g., non-compliance with treatment plans, missed appointments, change in patient’s needs, etc.]. Please note that our priority is always your health and well-being, and we encourage you to seek ongoing care with another provider who can better meet your needs moving forward.
We understand that finding a new provider can be challenging, and we are happy to assist in transferring your medical records to your new healthcare provider. Please complete the attached authorization form and return it to us at your earliest convenience.
If you have any questions or need further assistance, please feel free to contact our office at [Phone Number] or [Email Address]. We genuinely appreciate the opportunity to have cared for you and wish you the best in your continued health journey.
Sincerely,
[Your Name]
[Your Title]
[Healthcare Facility Name]
