ࡱ> -F,{ Bbjbjzz 4B||8EGGGGGG$kk EE+n 10h hh`kk"h| : Sample Letter for Closing Your Medical Practice (Type in physicians letterhead) (Date) Dear I am writing to advise you that I am retiring/have sold my practice, and will no longer be available to provide your medical care effective ___(date)________. I will be available until that time for your health care needs. Please select another physician within this time frame to continue your care or you may (insert any recommendation you have, i.e., continue with my medical group/Dr. xyz who bought my practice). In the alternative, you may call ___________________ (Physician Referral Service/County Medical Society) ______________________for assistance in selecting another physician. I am including a medical record request form that requires your signature and identification of the physician selected. Once my office receives the form, a copy of your records will be transferred within 15 days. (Insert if appropriate if you choose to remain with my medical group/Dr. xyz who bought my practice then no request is necessary). If you will not be the custodian of records because the medical group is retaining them or you are transferring the records to another doctor it is helpful to mention it, i.e., Dr. xyz or ABC Medical Group will be the custodian of your medical records effective__(date)____. Sincerely, Physician Name Enclosure Place a copy of the letter in the patient medical record. If you will not be the custodian of records it is helpful to retain a copy of the letter for your files should your receive a records request in the future. Reviewed 6/2013 /012QRS | }   Ƕ~mYE1&hu/hw6>*CJOJQJ^JaJ&hu/h%)6>*CJOJQJ^JaJ&hu/h?@P6>*CJOJQJ^JaJ hu/h%)CJOJQJ^JaJ#hu/h?@P>*CJOJQJ^JaJ#hu/hw>*CJOJQJ^JaJ&h$h?@P6>*CJOJQJ^JaJ hu/h?@PCJOJQJ^JaJhu/h?@PCJaJh$h?@P6OJQJh$hT6OJQJh$hmOJQJh$hTOJQJ01RSZ[\]bcF G   * + 6 7 8 9 H I J T U V $a$gdw 9 ? S T       $ ( ) * 7 8 I J V ﻩr^^MM hu/hu/CJOJQJ^JaJ&hu/hu/6>*CJOJQJ^JaJ#hu/hw6CJOJQJ^JaJ h$6>*CJOJQJ^JaJ&hu/h%)6>*CJOJQJ^JaJ#hu/h%)6CJOJQJ^JaJ#hu/hu/6CJOJQJ^JaJ hu/h?@PCJOJQJ^JaJ hu/hwCJOJQJ^JaJ hu/h%)CJOJQJ^JaJV ./012B$a$gdu/V .2;ABh%)h%)CJaJh[CJaJh%)CJaJh%)#hu/h%)5CJOJQJ^JaJ21h:pw/ =!"#$% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] B V B V B 8@0(  B S  ?DD9?ST$(67HI2AD;ADL&o2+%%)u/2<?@Pqim[C{;?@ABCDEHIJKLMNORoot Entry F"0nG1TablehWordDocument4SummaryInformation(DocumentSummaryInformation8$MsoDataStore @n+n44ZYJU012JTGPQ==21n@ nItem 2&PropertiesZ1E1SVQQPA==2 1n#nItem  PropertiesSITUG1XGNEA==2 1n&nItem PropertiesOGCROZRIGVQZ0==21n+nItem %eProperties?ACompObjEr This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision.   !"#$&'()*+,-./0123456789:;<=>@ABCDF DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm Document ID GeneratorSynchronous100011000Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandlerDocument ID GeneratorSynchronous100021001Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandlerDocument ID GeneratorSynchronous100041002Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandlerDocument ID GeneratorSynchronous100061003Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandler   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q