Bert: I have discussed this with a lawyer at my malpractice insurance company. There is no set rule, and you can give 15 days, but my company recommends 30 days. They have 30 days, period. They may come in for care during this time, but rarely have I seen this. Your scenarios:
1. I try to send a goodbye letter when people are leaving. It is like a discharge letter, but says it has come to my attention that they are leaving town, etc etc, and I feel it is important to start with a new doctor right away so all problems are addressed. I also tell them I will be 'closing their chart' in 30 days, but will send copies to new doc, sad to see them go, etc.
If they come back, they are not a new patient again until approved. They are generally new anyway after 3 years inactive.
2. You do not have to continue seeing them, as far as I undestand, if they have been hostile. Threatening is a whole new realm, and you cannot be asked to subject the staff to abuse. I have immediately discharged someone, asked they never return, and told them they are 'trespassed' from the property, and informed police. In such a case, they are arrested if they come back. They are told the ER is open 24 hours and it is really hard to claim abandonment when there is an ER and Urgent care down the block.
3. They CAN come in for this case. Make sure your staff knows they absolutely CAN come in over the next 30 days. I have seen offices where the nurse says "you can't come in until you pay the bill." That is WRONG and could lead to a lawsuit. They have a right to the care over 30 days as long as they have not been abusive. And yes, you may be treating them for free - but this has rarely ever happened. If you have a chance to talk with them and hand the letter, it saves postage. Document it was hand delivered to them or have them sign that they got it. When they pick up records, as I said, I have them sign receipt.
I found out this stuff because my previous partner gave me a bunch of vicious patients. I spoke with the lawyer at my insurance company. You can to, and I'd suggest it. They are glad to talk with you free so they can save themselves money!
