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1. Date and Contact Information: Current date and full contact details of both the dental practice and the patient
2. Formal Salutation: Professional greeting addressing the patient by name
3. Notice of Termination: Clear statement that the dental practice is terminating the professional relationship
4. Reason for Dismissal: Brief, professional explanation of the grounds for termination, stated objectively and without emotional language
5. Immediate Medical Needs: Statement addressing any immediate dental care needs and emergency care provisions
6. Transition of Care: Information about the timeline for termination and process for transferring care
7. Records Transfer: Information about how the patient can obtain their dental records
8. Local Dental Society Reference: Information about contacting the local dental society for referrals to other practitioners
9. Professional Closing: Formal closing with signature block including practitioner name and practice details
1. Outstanding Balance: Include when there are unpaid fees, detailing the amount owed and payment arrangements
2. Current Treatment Plan: Include when there is ongoing treatment that needs to be addressed or transferred
3. Special Circumstances: Include when dealing with specific patient conditions requiring special attention during transition
4. Insurance Information: Include when there are relevant insurance claims or coverage issues to address
5. Legal Requirements: Include specific references to relevant laws or regulations when dismissal involves reportable incidents
1. Patient Records Summary: Summary of recent treatments and current dental status
2. Transfer of Records Authorization Form: Form for patient to authorize transfer of records to new provider
3. Local Dental Resources List: List of local dental practices and emergency care facilities
4. Outstanding Treatment Plan: Detailed list of incomplete treatments and recommendations
Continuity of Care
Records Transfer
Patient Privacy
Emergency Care Provisions
Professional Obligations
Outstanding Payments
Immediate Medical Needs
Referral Process
Record Retention
Confidentiality
Regulatory Compliance
Treatment Completion
Patient Rights
Practice Contact Information
Healthcare
Dental Services
Medical Practice Management
Healthcare Administration
Professional Services
Insurance
Legal Services
Legal
Administration
Patient Relations
Records Management
Compliance
Risk Management
Front Office
Practice Management
Dentist
Dental Practice Owner
Practice Manager
Office Manager
Healthcare Administrator
Dental Office Administrator
Legal Compliance Officer
Risk Management Coordinator
Patient Relations Coordinator
Records Management Specialist
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