There are several important steps:

• Document everything the patient has or has not done which shows his/her non-compliance.
• Send the patient a letter (send both regular and certified mail) explaining the treatment recommended and the importance of compliance.
• You may indicate that continued non-compliance could result in termination of the physician-patient relationship.

Do not terminate the relationship during an acute situation which could lead to allegations of abandonment. Send the patient a letter (both regular and certified mail) indicating your desire to terminate the relationship; your willingness to handle any emergency situations for the next 30 days; and suggestions on where to find another dentist (i.e., County Medical Society). Clearly state what the patient's dental situation and needs are at this point, and let the patient know that you will be happy to furnish their new dentist with a copy of the patient's record.

*If the patient belongs to a managed care organization, you must first check with them to determine termination protocol, if any.

These records can prove to be very important in the defense of a claim. If possible, keep them indefinitely.

This varies from state to state. Contact Risk Management Services at Professionals Advocate for guidance on this issue.

You need to go through the appeals process with the managed care entity. Advise the patient your recommended treatment was not approved and give the patient their options (include paying for the recommended treatment themselves). Document #1 and 2.