A Letter Of Dismissal From Dental Practice is a critical document used when a dental practice needs to formally end its professional relationship with a patient. This may occur due to non-compliance with treatment plans, missed appointments, payment issues, or breakdown in the provider-patient relationship. The letter must carefully balance the practice's right to choose its patients with legal obligations under U.S. healthcare laws. It needs to provide adequate notice, ensure continuity of care, and maintain compliance with both federal regulations (such as HIPAA) and state-specific dental practice acts. The document typically includes provisions for emergency care during the transition period and information about records transfer.
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1. Patient Identification: Full name and relevant identifying information of the patient being dismissed
2. Effective Date: Clear statement of when the dismissal takes effect
3. Reason for Dismissal: Brief, professional explanation of dismissal grounds if appropriate
4. Continuing Care Provisions: Information about emergency care during transition period
5. Records Transfer Information: Process for obtaining medical records
1. Alternative Provider Recommendations: List of alternative providers, used when required by state law or as courtesy
2. Outstanding Balance Information: Include when there are unresolved financial matters
3. Ongoing Treatment Plan: Include when patient is in middle of treatment requiring completion
1. Records Release Form: Authorization form for transfer of records to new provider
2. Provider Directory: List of local dental providers accepting new patients
3. Outstanding Treatment Summary: Summary of incomplete treatment if applicable
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