SAMPLE TRANSITION LETTER Date Dear Adult Provider, It was nice to talk with you about my son/daughter and I’m grateful that you have agreed to be his health care provider. Name is an ?? year old male/female who will become a patient in your practice, once you have received his medical records from Dr. Pediatrician. Name acts/does not act as his own guardian. Enclosed is a copy of his supported decision making/guardianship paperwork for your records. He/She is insured by private insurance through his parents with a secondary payer of Traditional Medicaid. Name has several chronic conditions with related medications. A list of those medications and prescribing specialists are also included in this letter. Name is transferring from Dr. Pediatrician. He/She is prepared to continue to be a resource for you during this transition phase of Name’s care. Here is their contact information. Dr. Pediatrician 123 Oak Dr. Anywhere, IN 12345 Phone (123)456-7890 e-mail Sincerely Mary Smith Name’s Guardian/Parent Enclosed Guardianship/Supported Decision Making Specialist and Medication List
SAMPLE TRANSITION LETTER Date Dear Adult Provider, It was nice to talk with you about my son/daughter and I’m grateful that you have agreed to be his health care provider. Name is an ?? year old male/female who will become a patient in your practice, once you have received his medical records from Dr. Pediatrician. Name acts/does not act as his own guardian. Enclosed is a copy of his supported decision making/guardianship paperwork for your records. He/She is insured by private insurance through his parents with a secondary payer of Traditional Medicaid. Name has several chronic conditions with related medications. A list of those medications and prescribing specialists are also included in this letter. Name is transferring from Dr. Pediatrician. He/She is prepared to continue to be a resource for you during this transition phase of Name’s care. Here is their contact information. Dr. Pediatrician 123 Oak Dr. Anywhere, IN 12345 Phone (123)456-7890 e-mail Sincerely Mary Smith Name’s Guardian/Parent Enclosed Guardianship/Supported Decision Making Specialist and Medication List
Adult-PCP-Transition-Letter.docx