DISCHARGE NOTICE
Address:
Date:
/
Month
/
Day
Year
Date
Dear M (Name)
This letter serves as a Notice of discharge from :
The reason for your being discharge is that (check one)
Your needs cants be met this facility of you required care other than that which this facility is licensed and required to Provide, or medical reason as ordered by your physician.
Your health has improved and you no longer needs the services of this facility or the short term care period for which you are hear admitted has expired.
Your health/safety of others is endangered by you or your environment.
Your health or safety is endangered by the medical emergency or disaster.
You are non compliance with our services and recommendations.
Verbal/sexual abuse.
Aggressive behavior/ non-professional demand of services.
Asking for same employee/therapist/nurse/aid throughout the course of the treatment.
The anticipated date of discharge is
/
Month
/
Day
Year
Date
We recommend :
You to find an another home healthcare agencies for your services. If you need any help to finding the new agencies
You ask your case manager/doctors to help to find home health care agencies for your services.
In the case of emergency please call 911 or go to the nearest emergency room.
We will continue providing the service until ___________________ Depending on the availablity of the staffing.
If
y
ou
ha
v
e
any
questions
about
the
contract,
please
f
eel
fr
ee
to
call
at
740-362-5035
.
Thank you
Sincerely,
Name
Signature ( Company Management)
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