Guidelines for Discharging Patients
All requests to discharge patients for non-compliance in any of the three identified categories - -
patient attendance, clinical (including violation of Controlled Substances Agreements) or behavioral must
be submitted in writing and forwarded to the Practice Supervisor where the patient receives services.
The Practice Supervisor will investigate the request and execute the appropriate procedure(s) that are
listed further in this handout.
If the circumstances of a case are particularly complex, the Practice Supervisor, at her/ his discretion,
may consult with the E/TFHC’s Director of Quality and Disease Management for additional review and
feedback. In such instances, the Quality Director will also investigate the matter. Collectively, those
administrators will determine the course-of-action to take:
1) If the request has merit based upon the content of this policy, both the Practice
Supervisor and the Quality Director will sign the request and the Practice
Supervisor will execute the actions listed below.
2) If the request is denied, the following administrative staff will meet with the
Quality Director and the Practice Supervisor to determine a course-of-action for
a) Attendance Non-compliance: Executive Director
b) Clinical Non-Compliance: Medical Director + attending Provider
c) Behavioral Non-Compliance: Executive Director
STEPS IN NOTIFYING/DISCHARGING PATIENTS.
Based upon the circumstances of the request, the following steps should occur when notifying a patient at
he/she is being discharged:
1) The appropriate written notice (i.e., letter) will be generated and forwarded to the
patient via registered mail (i.e., requiring a return signature upon receipt). Please note that
depending upon the issue for which the patient is being discharged - - i.e., attendance,
clinical or behavioral - - several levels of notification can occur before the final discharge
letter is sent (see Policy AD 113 “Discharging Patients.”)
2) A copy of the letter should be filed in the patient’s chart.
3) If the patient has been sent a discharge letter, the following actions will occur:
a) The patient’s “discharged” status will be recorded in the patient’s
medical record (Medmate) under area “f8” of the patient demographic
screen as well as the effective date and the reason for discontinuing
b) All future non-emergent appointments will be cancelled.
c) A memo or e-mail will be sent to the Practice Supervisors or Office
Coordinator’s at every E/TFHC clinical site regarding the patient’s status
(please refer to item 3.a. below).
d) Receipt of the Post Office’s signed notice will be filed in the patient’s Medical Record,
(i.e., paper copy) as well as noted in area f8” of the patient demographic screen of the
patient’s MedMate record- - i.e., the date the notice was received.
e) If the notice is returned without signature by the Post Office, the
unopened letter and envelope will be filed in the patient’s medical record.
f) If the patient contacts the office at a later date, after confirming the
identity of the patient, he/she will be verbally informed of his/her
discharge. In addition, a second copy of the discharge letter will be sent
via registered mail.
g) All discharged patients will have direct clinical services discontinued as
of the date of the notification letter and patients’ clinical practitioners only
will provide urgent care services, if needed, for up to thirty (30) days of
the date of the notification letter. The E/TFHC’s Executive Director must
approve any exceptions to this procedure.
1) Once a patient has been discharged from one E/TFHC service location, he/she will be
considered to have been discharged from all E/TFHC locations. The Practice Supervisor/Office
Coordinator who forwards the patient his/her discharge letter is also responsible for notifying all
other E/TFHC service locations of the patient’s termination status.
2) If a patient has been discharged from the E/TFHC for non-compliance as outlined in this
policy, and he/she requests to become an active patient again, he/she MUST meet with
the Practice Supervisor of the Health Center involved before being reinstated. In such
instances, the Practice Supervisor will, prior to meeting with the patient, meet with the
patient’s most recent provider, the E/TFHC Medical Director and the Executive Director to
review the request and make a determination regarding the request. Prior to the patient
becoming “active” again, the patient, in writing, must agree to a contract that outlines the
E/TFHC’s expectations and contingencies for remaining an active patient going forward.
PATIENT DISCHARGE REQUEST
Patient Name: Pt. No:
Within the next five (5) business days, please take the following action with the above-named patient
1. Non-Compliance: Patient Attendance guidelines
Send First Notification (letter re: items, 1, 2 or 3)
2. Non-Compliance: Behavioral
Send Second Notification (letter re: items 1 or 3)
3. Non-Compliance: Clinical/Medical
Send Letter re: Discontinuation of Pain Management Tx.
4. Non-Compliance: Controlled Substances Agreement
Send Letter re: Discharge from E/TFHC.
5. Other (please explain below)
I. DESCRIPTION of SITUATION: (if needed)
Staff Member Site Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Practice Supervisor Site Date
Director of Quality & Disease Management Site Date
Request Approved. First / Second Letter re: sent on:
Request Approved. Discontinuation of Pain Management Tx Letter sent on:
Request Reviewed and Forwarded to Director of Quality & Disease Management on:
Request Approved. Discharge Letter sent on:
[Note: Please use back of form to note additional information; please attach any pertinent documentation]