When can I withdraw from a patient's care?
You may have a patient you no longer wish to treat. Chronic non-compliance, for example (which should be well documented in the patient's chart), could lead to a decision to withdraw from a patient's care.

While you have a right to withdraw from the care of a patient for any reason, appropriate procedures are necessary in order to minimize the risk of allegations of abandonment.

Be sure to consider the patient's condition. If you have already agreed to treat a particular acute medical condition, you should render the promised care before considering withdrawal. After treatment has concluded, you may withdraw from treatment if the patient is given appropriate notice of your intent. See "How do I terminate a patient relationship."

How do I terminate a patient relationship?
When you decide to withdraw from a patient's care, notify the patient in writing in order to avoid a claim of abandonment. You must give the patient sufficient time to locate another doctor (30 days is recommended).

Send a formal discharge letter that includes:

• a statement of intent to withdraw from treatment
• the date upon which treatment will cease
• name and phone number of a local referral service, county medical society or state medical association to help patient locate another doctor
• an offer to forward medical records to another doctor
• an offer to provide emergency treatment during the transition period

Send the letter via both regular and certified or registered mail; the return receipt will serve as proof that you tried to contact the patient. File the receipt and a copy of the letter in the patient's medical record.

Sample letter (also in A Reference Tool for Risk Management)

How do I add or make a change to a medical record?
Don't squeeze missing information between existing notes; use the next available full line. Date the additional information and note the reason for the entry.
If you need to correct an error, do not obliterate it. Draw a single line through the text so that original information is still readable. Write error, date, and initial the strike through. Record the correct information.

Following these guidelines will help you avoid allegations of record tampering. Remember, NEVER alter your records in preparation for a lawsuit.

How long do I need to keep patient records?
State laws mandate how long you must retain records. You should also consider a state's statute of limitations, which can be different from retention rules. FPIC recommends keeping your records for at least the maximum time mentioned in the statute of limitations, no matter the allegation. For instance, in Florida, the statute of limitations for allegations of fraud and misrepresentation is 7 years.