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Terminating the Dentist/Patient Relationship This article appeared in the Spring 1997 issue of Preventive Action, published by the Florida Physicians Insurance Company (EPIC). Once a dentist begins

How to fill out terminating form dentistpatient relationship

Point by point guide on how to fill out a terminating form for a dentist-patient relationship:

1. Begin by clearly stating your intention to terminate the dentist-patient relationship. This can be done by including a heading such as "Terminating Form Dentist-Patient Relationship" at the top of the document.
2. Include the date of termination. Specify the exact date when the dentist-patient relationship will cease to exist. This helps maintain clarity and avoids any confusion regarding the timeframe.
3. Provide the reason for termination. It is important to state the reason for ending the dentist-patient relationship. This can be due to various factors such as relocating, changing dental providers, or dissatisfaction with the services provided. Clearly articulate the reason to ensure mutual understanding.
4. Indicate any outstanding financial obligations. If there are any pending fees or outstanding payments, make sure to mention them in the form. Specify the amount owed and the preferred method of payment.
5. Mention the transfer of dental records. If the patient wishes to transfer their dental records to another dentist, include the necessary instructions for the record transfer. This ensures continuity of care and provides the new dentist with the patient's comprehensive dental history.
6. State the patient's responsibilities post-termination. It is important to outline the patient's responsibilities after the termination of the dentist-patient relationship. This may include finding a new dental provider, scheduling any follow-up appointments, or taking care of any dental issues that were previously discussed.

Who needs a terminating form for a dentist-patient relationship?

1. Patients who wish to formally end their relationship with their current dentist.
2. Dentists who have determined that it is necessary to terminate the dental care they provide to a patient, for reasons such as non-compliance, abusive behavior, or failure to make payment.
3. Patients who are relocating or seeking dental care elsewhere due to personal or professional reasons.

By following these points, both patients and dentists can ensure a smooth and mutually agreed termination of their dentist-patient relationship.

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What is terminating form dentistpatient relationship?

The terminating form dentistpatient relationship is a document that officially ends the relationship between a dentist and a patient.

Who is required to file terminating form dentistpatient relationship?

The terminating form dentistpatient relationship must be filed by the dentist.

How to fill out terminating form dentistpatient relationship?

The terminating form dentistpatient relationship can be filled out by providing details about the patient, reason for termination, and any follow-up care information.

What is the purpose of terminating form dentistpatient relationship?

The purpose of the terminating form dentistpatient relationship is to formally end the professional relationship between a dentist and a patient.

What information must be reported on terminating form dentistpatient relationship?

The terminating form dentistpatient relationship must include patient details, reason for termination, and any follow-up care information.