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Fill and Sign the Termination of Physicians Care Patient to Doctor Form

Fill and Sign the Termination of Physicians Care Patient to Doctor Form

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Open the document and fill out all its fields.
Apply your legally-binding eSignature.
Save and invite other recipients to sign it.

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In str u ctio n: T his i s a m odel l e tte r. A dap t t o f it y our f a cts a n d c ir c u m sta n ces. R etu rn a d dre ss:N am eAddre ss L in e 1A ddre ss L in e 2C ity , S ta te Z ip C ode D ate N am eCom pan yA ddre ss L in eC ity , S ta te Z ip C ode R e: Term in atio n o f P hysic ia n ’s C are – P atie n t t o D octo r D ear D r. : I a m w ith dra w in g m yse lf a s y our p atie n t. I h av e b een a p atie n t o f y ours fo r th e p ast 6 mo nth s. I n th e f o ur tim es th at I h av e b een to s e e y ou, I h av e h ad le ss th an a d eq uate s e rv ic e. T hre e ou t o f f o ur t im es, y ou h av e b een a n h our l a te i n s e ein g m e. I n a d ditio n, y our l a ck o f c o m munic atio n mak es m e c au tio us to a m is h ap o ccu rrin g. F or e x am ple , a t m y la st v is it, w hen I s a id I h ad a b ack pain , y ou im med ia te ly d ia g nose d th at I p erh ap s h ad k id ney p ro ble m s. H ow ev er, afte r v is itin g anoth er p hysic ia n , I le arn ed th at I ju st h ad p ulle d a m usc le . For th e sa fe ty o f m y lif e , I am with dra w in g m y f ile s. S in cere ly ,N A M E

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Here is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Need help? Contact Support
Patient initiated termination of care
Reasons for removal from GP list
terminating physician-patient relationship sample letter
Patient removal from GP list
GMC guidance on removing patients from list
Breakdown in doctor-patient relationship
Removal of patient from GP list letter
if a physician decides to terminate his care of a patient, the physician must

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