Formulating a Discharge Letter from Your Practice
When discharging a patient from your outpatient practice (as opposed to hospital discharge), create a brief, professional letter that documents the termination of the physician-patient relationship, provides adequate notice (typically 30 days), offers emergency care during the transition period, and assists with finding alternative care—all while maintaining clear documentation to protect both parties.
Core Components of a Practice Discharge Letter
Essential Elements to Include
Clear statement of termination: Explicitly state that you are ending the physician-patient relationship, effective on a specific date (typically 30 days from the letter date) to provide reasonable notice and avoid abandonment claims 1
Reason for discharge (optional but recommended): While not legally required, briefly stating the reason (e.g., non-compliance with treatment, missed appointments, breakdown in communication) provides clarity and documentation, though avoid inflammatory language 1
Transition period care: Specify that you will provide emergency care only during the 30-day notice period, and clarify what constitutes an emergency versus routine care 1
Assistance with finding new provider: Offer to provide names of other physicians or refer to local medical society/insurance provider directories to help the patient find alternative care 1, 2
Medical records transfer: State that you will transfer complete medical records to the new physician upon receiving a signed authorization from the patient 3, 1
Medication refills: Clarify your policy on prescription refills during the transition period (typically limited to 30-day supply or until first appointment with new provider) 4
Documentation and Communication Standards
Written format: Always provide written notification via certified mail with return receipt requested to document that the patient received the letter 1
Copy for medical record: Retain a copy of the discharge letter and the return receipt in the patient's permanent medical record 3, 1
Avoid emotional language: Keep the tone professional and factual, avoiding judgmental or accusatory statements that could be used against you in litigation 1, 5
Sample Structure
Opening paragraph: "This letter is to inform you that I will no longer be able to provide medical care for you as of [date 30 days from letter]. This decision is due to [brief, factual reason if appropriate]."
Second paragraph: "During the next 30 days, I will be available to provide emergency care only. For routine medical needs, you should begin seeking care from another physician immediately."
Third paragraph: "I recommend that you contact [local medical society/insurance company] to find a new physician. Upon receiving your written authorization, I will transfer your complete medical records to your new provider."
Closing paragraph: "I will provide prescription refills for up to 30 days or until you establish care with a new physician, whichever comes first. Please contact my office if you need assistance during this transition."
Critical Pitfalls to Avoid
Insufficient notice period: Providing less than 30 days notice may constitute patient abandonment, particularly if the patient has ongoing medical needs or chronic conditions 1
Failure to document: Not keeping proof of delivery (certified mail receipt) leaves you vulnerable to claims that the patient never received notice 1
Refusing emergency care during transition: You must provide emergency care during the notice period; refusing to do so constitutes abandonment 1
Inadequate assistance with transition: Simply telling a patient to "find another doctor" without providing resources or assistance may be considered abandonment 2
Discharging during acute illness: Avoid discharging patients who are in the middle of acute treatment or unstable conditions, as this significantly increases abandonment risk 1