Sample Patient Termination Letter Due to Non-Compliance

Download this Sample Patient Termination Letter Due to Non-Compliance Design in Word, Google Docs, PDF, Apple Pages, Outlook Format. Easily Editable, Printable, Downloadable.

As a doctor, you are within your rights to terminate a patient from your practice with the use of the Free Patient Termination Letter Due to Non-Compliance template. If they fail to cooperate, you are free to download this, at no cost to you, and make good use of it.

[DATE]

Dear [RECIPIENT NAME],

I regret to inform you that I will no longer be able to serve as your doctor as of [DATE]. It was a difficult decision to make considering that you have been my patient for [NUMBER] years. However, your continued failure to cooperate with my prescribed medical care plan and your unjustified refusal to take your prescribed medication left me no choice but to terminate our physician-patient relationship.

I highly recommend that you immediately seek the services of another physician to attend to your medical needs. In the meantime, my services will be available to you only in the event of an emergency. Here are some physicians that I know are currently accepting new patients:

[LIST]

I will be available to discuss with your new physician on any matter regarding your health.

Thank you and I wish you good health in the future.

Regards,

[YOUR SIGNATURE]

[YOUR NAME]