Paxson Question of the Month (Vol. 9: Valid Reasons for Patient Dismissal)

Each month, we feature a real question asked by one of your fellow ICS members through Paxson, our closed-system AI assistant built just for Illinois chiropractic physicians. Paxson provides quick, accurate, and member-directed support on a wide range of topics—from insurance issues and licensure requirements to documentation, compliance to social media posts, and more.

These featured questions offer valuable insights you can use in your own practice—and serve as a reminder that help is just a click away.

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Have a question? Paxson is ready when you are at www.ilchiro.org/paxson.

Important Note: The ICS strongly encourages our doctors to provide more detail when asking their initial questions. Although Paxson will make an effort to understand context, we believe the results it provides will be much closer to your needs when members provide longer questions/prompts that give greater context.

Valid Reasons for Patient Dismissal

ICS Member Question:

“can i refuse or dismiss patients based on politics”

Paxson’s Response:

No, you should not refuse or dismiss patients based on their political beliefs or affiliations. The professional and legal standards for terminating a patient relationship in Illinois do not include political views as a valid reason for dismissal.

Acceptable reasons for discharging a patient include:

• Repeated failure to follow medical advice
• Chronic missed appointments
• Inappropriate behavior (such as physical advances or significant disruption)
• Non-payment of fees (with some caveats for patients under acute care)

Any discharge must be handled carefully to avoid patient abandonment. This means providing sufficient notice (typically at least 30 days), ensuring the patient has time to find another provider, and not interrupting care in a way that could cause immediate harm.

If you are considering dismissing a patient, it is essential to base your decision on objective, patient-care-related reasons and to follow proper procedures for notification and transition of care.

ICS Member Followup:

“can i refuse or dismiss patients based on religion”

Paxson’s Response:

No, you should not refuse or dismiss patients based on their religion. The standards for terminating a patient relationship in Illinois do not include religion as a valid or ethical reason for dismissal. Acceptable reasons for discharging a patient are limited to issues such as:

• Repeated failure to follow medical advice
• Chronic missed appointments
• Inappropriate behavior (such as physical advances or significant disruption)
• Non-payment of fees (with some caveats for patients under acute care)

Refusing or dismissing a patient based on religion could be considered discriminatory and may violate ethical standards and potentially state or federal anti-discrimination laws. All patient dismissals must be handled with care to avoid patient abandonment, which includes providing written notice (typically at least 30 days), allowing time for the patient to find another provider, and ensuring continuity of care.

Would you like a checklist or step-by-step guide for properly dismissing a patient in compliance with professional standards?

ICS Member Followup:

“yes”

Paxson’s Response:

Here is a step-by-step guide for properly dismissing a patient in compliance with professional standards and to avoid patient abandonment:

Step-by-Step Guide for Dismissing a Patient

1. Confirm Valid Reason for Dismissal

Ensure the reason for dismissal is objective and related to patient care (e.g., repeated missed appointments, non-compliance, disruptive behavior, non-payment of fees—not based on religion, race, gender, or other protected characteristics).

2. Assess Patient’s Current Condition

   – Do not dismiss a patient who is in acute care or whose health could be immediately jeopardized by termination. If the patient is under active treatment, delay dismissal until it is safe to transition care.

3. Prepare Written Notice

• Draft a formal letter to the patient. The letter should include:
  • The reason for dismissal (stated professionally and objectively).
  • The effective date of termination (allow at least 30 days from the date of the letter).
  • A statement advising the patient to seek care from another provider.
  • Information on how to obtain or transfer medical records.
• Optionally, provide the name of another provider, a referral service, or the local health department.

4. Send the Notice Properly

   – Send the dismissal letter by certified mail or another trackable carrier to the patient’s last known address. Retain proof of delivery for your records.

5. Provide Continuity of Care

   – During the notice period (typically 30 days), continue to provide necessary care or make arrangements for urgent needs.

   – If the patient seeks care during this period, assess the urgency and provide care or assist with transition as appropriate.

6. Document Everything

   – Keep detailed records of the dismissal process, including the reason for dismissal, the notice sent, and any communications with the patient regarding ongoing care or records transfer.

7. Handle Medical Records Appropriately

   – Inform the patient how to request their medical records or have them transferred to a new provider.

   – Ensure records are maintained and accessible according to legal requirements.