LETTER TO PATIENTS: A CLINICIAN IS LEAVING THE PRACTICE

[Practice name]
[Address]
[Phone, email, and patient portal]

Date: [Date sent]
To: [Patient's full name]
Sent by: [Mail, patient portal, or email]

Dear [Patient name],

[Clinician's name and credentials] will see patients at [practice name] until [last day, with the weekday]. [One sentence on the reason, if the clinician wants to share it, or delete this line]

YOUR CHOICE
Where you get care from here is your decision. Both options below are open to you.

Stay at [practice name]: [The clinician who will take over your care, from what date, and whether you need to do anything]
Move with [clinician's name]: [New practice name, address, phone, and opening date, or: This option isn't available, because the new role won't include patients from this practice]

YOUR RECORDS
Kept by: [Practice name, or the clinician, as the practice agreement says]
Copies or a transfer: [How to ask, the form to sign, any fee, and how long it takes]

RESULTS, REFERRALS, AND PRESCRIPTIONS
Results that arrive after [last day]: [Name of the clinician who will review them and contact you]
Referrals already sent: [Where the specialist's report will go, and whom to call about an appointment]
Prescriptions: [How to renew before and after the last day]

IF YOU NEED CARE IN THE MEANTIME
[Same-day appointments, the after-hours line, and when to go to an emergency department]

[A thank-you from the clinician, in 1 or 2 sentences]

Questions: [Name, phone, or email of the contact at the practice]

[Clinician's name, credentials]
[Name and role of the person signing for the practice]