Risk Management

Noncompliant Patient (Sample Letter)

This sample letter is provided as a guideline only and should be modified according to the situation. Send the letter via regular mail, and add the words “Address service requested” on the front of the envelope either below your address or above the patient’s address. Be sure to place a copy of the letter in the patient’s chart. To have OMIC review your letter, please fax it to 415-771-1095 or email it to riskmanagement@omic.com.


Sample Letter:  Noncompliant Patient (Gives Patient One Last Chance)



Dear (Patient):

You have canceled your follow-up appointment on (date) without rescheduling. We have tried multiple times to reschedule your missed appointment. To date, you have not responded to our efforts. It is our understanding that you may have terminated your care with our office. 

Continued care is essential to the health of your eyes. You have an eye condition which will worsen without proper care (If the patient has a condition that requires specific care, state the care AND the consequences of  no care in clear, patient-friendly language.  If the patient has a condition that needs regular follow-up, state the frequency and urgency of the follow-up, AND state the consequences of not getting the follow-up at the recommended time in clear, patient-friendly language.)  Permanent damage may occur, resulting in visual loss or blindness. Kindly realize this letter is not meant to alarm you. We only wish to inform you of the seriousness of your condition, which we explained during office visits, and encourage you to seek proper care.

If we have not heard from you within three weeks, we will assume that you have transferred your care to another physician and have terminated your relationship with this office. We will transfer a copy of your medical records to your new physician upon receipt of a signed authorization to do so.  An authorization form is enclosed for your convenience.

With best regards, 

(Physician’s Signature & Name)


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