Doctor Release Form - Canada

Doctor Release Form for Canada

Doctor Release Form Template for Canada

A Doctor Release Form is a legal document used in Canadian healthcare settings to formally terminate a doctor-patient relationship. This document complies with provincial healthcare regulations and professional medical standards, providing a clear record of the patient's voluntary decision to end the professional relationship with their physician. It includes essential information about medical records transfer, ongoing care responsibilities, and acknowledgment of the implications of terminating the medical relationship. The form ensures compliance with provincial health privacy laws and medical practice regulations while protecting both the physician's and patient's interests.

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What is a Doctor Release Form?

The Doctor Release Form serves as a crucial legal document in Canadian healthcare practices, used when a patient wishes to formally end their professional relationship with a physician or when a physician needs to document the termination of care (subject to professional obligations and notice requirements). This document becomes necessary in various situations, such as patient relocation, transfer of care to another provider, or practice closure. The form includes critical elements such as patient identification, physician details, effective date of release, provisions for medical records transfer, and acknowledgment of understanding regarding continuity of care. It must comply with provincial healthcare regulations, privacy laws, and professional medical standards while ensuring clear documentation of the termination process. The document helps protect both healthcare providers and patients by clearly defining the end of the professional relationship and respective responsibilities.

What sections should be included in a Doctor Release Form?

1. Patient Information: Full legal name, contact information, and any relevant patient identification numbers

2. Physician Information: Name, practice details, and professional registration number of the physician being released

3. Statement of Release: Clear declaration of patient's intention to terminate the doctor-patient relationship

4. Effective Date: Specific date when the release becomes effective

5. Acknowledgment of Records: Statement regarding the handling and transfer of medical records

6. Patient Rights and Responsibilities: Outline of patient's understanding of their responsibilities in seeking new medical care

7. Signature Block: Space for patient signature, date, and witness signature if required

What sections are optional to include in a Doctor Release Form?

1. Ongoing Treatment Acknowledgment: Used when patient is currently under active treatment that needs to be transferred or completed

2. Emergency Care Provision: Include when there's a need to specify conditions under which the physician may provide emergency care during transition

3. Specialty Care Referrals: Used when there are active referrals or ongoing specialist care arrangements that need to be addressed

4. Prescription Management: Include when there are current prescriptions that need to be addressed or transferred

5. Insurance/Billing Information: Used when there are outstanding financial matters or insurance claims to be resolved

What schedules should be included in a Doctor Release Form?

1. Current Medication List: List of all current prescriptions and medications

2. Active Referrals Schedule: List of any ongoing referrals to specialists or other healthcare providers

3. Medical Records Request Form: Standard form for requesting transfer of medical records to a new healthcare provider

4. Outstanding Tests/Procedures: List of any pending medical tests or procedures that have been ordered but not completed

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Cost

Free to use

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Medical Services

Private Medical Practice

Hospitals

Medical Insurance

Healthcare Administration

Medical Records Management

Relevant Teams

Legal

Medical Administration

Compliance

Risk Management

Patient Services

Records Management

Practice Operations

Quality Assurance

Patient Care

Administrative Support

Relevant Roles

Physician

Family Doctor

Medical Practice Manager

Healthcare Administrator

Medical Records Officer

Legal Compliance Officer

Medical Office Assistant

Healthcare Facility Director

Risk Management Officer

Patient Care Coordinator

Medical Practice Administrator

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What schedules should be included in a Doctor Release Form?

Authors

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