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The Medical Cancellation Letter is a crucial document used in the Philippine healthcare system when terminating professional medical services between a healthcare provider and patient. It serves as an official record of service termination and must comply with various Philippine regulations, including the Universal Health Care Act, Data Privacy Act, and relevant DOH Administrative Orders. This document is typically used when medical services need to be discontinued due to various reasons such as practice closure, patient transfer, or other professional circumstances. The letter must include specific elements such as clear termination notice, effective dates, transition of care information, and any relevant legal disclaimers. Its format and content are designed to protect both the healthcare provider and patient while ensuring continuous patient care and proper documentation under Philippine law.

1. Header Information: Complete contact information of both the healthcare provider and patient, including names, addresses, and relevant reference numbers

2. Date: Current date and any relevant reference dates (e.g., last appointment date)

3. Subject Line: Clear indication that this is a medical service cancellation notice

4. Formal Notification: Clear statement of the cancellation of medical services

5. Reason for Cancellation: Brief, professional explanation of the grounds for cancellation

6. Effective Date: Specific date when the medical service relationship will end

7. Transition of Care: Information about transferring medical records and referrals to other healthcare providers

8. Outstanding Matters: Discussion of any pending treatments, prescriptions, or financial obligations

9. Closing Statement: Professional conclusion with any necessary legal disclaimers

10. Signature Block: Healthcare provider's signature, name, title, and professional license number