Risk Management

Noncompliant Patient Missed or Cancelled Appointment (Sample Letter)

NOTE:  This sample letter is provided as a guideline only and should be modified according to the situation. Be sure to place a copy of the letter in the patient’s chart.  If the patient’s condition warrants a receipt, ask for delivery verification (DV).  DV is cheaper than certified, and does not require the patient’s signature.  Instead, the mail carrier verifies that the letter was delivered.   If DV is not available, send the letter certified and through the regular mail.  Place the letter and the verification or signed return receipt in the patient’s chart.

[SENT WITH DELIVERY VERIFICATION OR CERTIFIED MAIL-RETURN RECEIPT REQUESTED (send also through regular mail)

only if patient risks serious vision loss, otherwise use regular mail]

(Date)

Dear (Patient):

You have canceled your follow-up appointment on (date) without rescheduling. We were unable to reach you by telephone.

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, as it was also explained during office visits, and encourage you to seek proper care.

Please contact our office as soon as possible to reschedule.

With best regards,

(Physician’s Signature & Name)