Patient Initiated Termination of Care Letter

Last Updated: April 28, 2024

Patient Initiated Termination of Care Letter

Lesa Shaw
1234 Maple Street
Anytown, AN 12345
[email protected]
February 26, 2024

Dr. Jane Doe
Anytown Medical Clinic
5678 Clinic Way
Anytown, AN 12345

Subject: Termination of Medical Care Services

Dear Dr. Doe,

I am writing to formally inform you of my decision to terminate my medical care services under your supervision. This has been a difficult decision, influenced by a thorough consideration of my health needs and future goals.

Since starting my treatment on January 1, 2023, I have greatly valued your expertise and the support provided by your clinic. Nevertheless, I believe that seeking a new healthcare provider is necessary for my ongoing health journey and aligns more closely with my current preferences and objectives.

I kindly request the transfer of my medical records to facilitate a smooth transition to a new healthcare provider. Please inform me of the necessary steps and any associated costs for the secure transfer of these documents.

If needed, I am open to scheduling a final appointment to discuss my decision and ensure a comprehensive handover of my medical care.

Please accept this letter as a formal 30-day notice of my intent to discontinue my care with you, effective March 28, 2024. I trust this provides ample time for any required administrative actions.

I wish to thank you and your team for the care and attention I have received. Your professional dedication is highly appreciated, and I am grateful for the time I have spent under your care.

Thank you for your understanding and for assisting with my transition. Should you require any further information, please feel free to contact me at 555-123-4567 or [email protected].


Lesa Shaw

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