A Physician’s Guidefor Departing or Closing a Medical · PDF fileA Physician’s...

A Physician’s Guide forDeparting or Closing aMedical Practice

Illinois State Medical Society

www.isms.org

A Physician’s Guide for Departing or Closing a Medical Practice

ii This is for educational purposes and is not intended as nor should be considered legal advice ©2014 Illinois State Medical Society

Table of Contents

Introduction ________________________________________________________ pg. 1

Advance Planning ____________________________________________________ pg. 2

Notifying Patients of Departure From or Closure of Practice _________________ pg. 2

Medical Records Retention ____________________________________________ pg. 3

Physician Licenses and Prescription Pads _______________________________ pg. 5

Medications, Supplies and Books ______________________________________ pg. 5

Physician Professional Liability Insurance ________________________________ pg. 6

Selling the Medical Practice ___________________________________________ pg. 6

Dissolution of A Medical Corporation ____________________________________ pg. 7 Steps to Take Following a Physician’s Death _____________________________ pg. 8

Appendix A _______________________________________________________ pg.11 Checklist

Appendix B _______________________________________________________ pg. 14 Sample Practice Closure Letter: Patient Notification (Physician Retirement or Closure)

Appendix C _______________________________________________________ pg. 15 Sample Practice Closure Letter: Patient Notification (Physician Departure)

Appendix D _______________________________________________________ pg. 16 Sample Practice Closure Letter: Patient Notification (Physician Death)

Appendix E _______________________________________________________ pg. 17 Model Authorization for Release of Confidential Health Information

We hope you will find this information helpful in meeting your personal and professional needs

and requirements. This booklet was prepared by the ISMS Medical Legal Council. For additional

information, see "Closing Your Practice: 7 Steps to a Successful Transition" (AMA 1997) and

“Valuing, Selling, and Closing the Medical Practice” (AMA 2011).


1This is for educational purposes and is not intended as nor should be considered legal advice©2014 Illinois State Medical Society

Introduction

When a physician decides to change, depart or close a medical

practice, it is often a difficult and emotional decision. A practice

may be closed for many reasons, such as the physician’s

retirement, the physician’s relocation to another geographic

location outside the current patient population area (or to a

different practice or medical group in the same area), sale of

the practice to a management entity, or the physician’s

death or serious illness. Changing, departing or closing a

practice for whatever reason must be done carefully to

protect both the patients and the physician.

This booklet is intended to assist both a physician who

departs, closes or sells a medical practice and the

partners or surviving family members of a seriously ill or

recently deceased physician. It is an informational

document and should not be considered legal advice,

nor should it be taken as such. The Illinois State Medical

Society (ISMS) provides the following information as a

service to its members and their families to be used as a

starting point during this difficult, emotional and confusing

period. You will need to seek personal legal advice for

your specific circumstances.


2 This is for educational purposes and is not intended as nor should be considered legal advice ©2014 Illinois State Medical Society

Advance Planning

Physicians can partially alleviate the stress that accompanies the departure from or closure of a medical practice with good advance planning. Advance planning is the best insurance for dealing with the intricacies of departing from or closing a medical practice. Such planning will also make this difficult task less confusing and permit the process to be organized and comprehensive.

When a physician departs or closes a practice, numerous parties will need to be contacted and informed of the situation, documents will need to be obtained, and actions will need to be taken.

The parties, materials, and activities involved will vary from physician to physician, depending greatly on the type of medicine practiced. It is in the physician’s best interest to create a list of the steps needed to depart or close a practice while the medical practice is active, and to update the list periodically to include or delete certain persons, documents or entities as appropriate. Revisions should be dated.

General information and a checklist of items that should be completed by every physician for future use are included in the back of this document. However, here are a few things to note:

First, the physician should ensure that his or her spouse or another trusted individual is acquainted with the important persons in the physician’s professional and financial arenas, so he or she will feel comfortable contacting these people and asking for help if the need arises.

Second, the physician should ensure that his or her family has sufficient cash available to cover expenses that surface when a physician’s sudden death or illness occurs.

Finally, documents that a physician’s family may need immediate access to should not be placed in a safety deposit box, since it may be sealed after the physician’s death.

Notifying Patients of Departure From or Closure of Practice?Every physician who changes practice settings or closes a practice should fully and clearly inform active patients of this change. Physicians should provide 60 to 90 days notice, when possible, to allow patients the opportunity to obtain alternative care. Further, state law requires a physician to provide the public with at least 30 days prior notice of the closure of his or her practice. The notice must include an explanation of how copies of the physician’s records may be accessed by patients. The notice may be given by publication in a newspaper of general circulation in the area in which the physician practices. Such a notice generally appears in the public notice section of the newspaper. (735 ILCS 5/8-2001)

Depending upon the situation, the physician may be the one to provide notice, or the practice may insist on providing notice on behalf of the physician. Employment contracts should be reviewed to determine who is responsible for providing notice, and efforts should be made to ensure notice is given when the practice is the responsible party. Additionally, employment contracts may govern what information a physician is allowed to disclose to patients regarding his or her departure from a practice. Some departures from practices may be amicable, but it is possible to have a difficult separation. Although a contract may be in place, it is ultimately the physician’s responsibility to notify patients in order to avoid claims of abandonment.

When closing or departing from a practice, a physician’s first and foremost duty is to the patients. Physicians must not abandon their patients. The closure or departure should be accomplished in such a manner that allows patients sufficient time to secure the services of another physician of their choice. Typically, a physician will verbally let active patients know that he or she is considering closing the practice well in advance of any final closure. Failure to notify patients of a physician’s departure from or closure of a practice may result in a claim of abandonment and possible licensure actions by the Illinois Department of Financial and Professional Regulation (IDFPR).

Additionally, formal notice of actual closure or departure from a practice should be in writing to all active patients. Active patients are those who will probably call on the physician in time of present need. The AMA has provided the following guidance:

The physician should ensure that his or her spouse or another trusted individual is acquainted with the important persons in the physician’s professional and financial arenas ...



Unfortunately, defining what constitutes an active patient is not always easy; legal consultation to help determine which patients need to be contacted may be advisable. At a minimum, however, it’s likely you’ll need to notify all patients who have been seen within the past two years, as well as all patients who have chronic or complicated conditions, so that you can help them arrange for future treatment.

Closing Your Practice, p. 5. (AMA 1997)

While active patients are generally those who the physician has seen within the past two years, this figure varies by specialty. The notification should provide at least 60 days’ notice, when possible, to allow patients the opportunity to obtain alternative care. Patients should be advised to seek alternative care and be assured that the physician will provide necessary care until a certain date. This notification should also inform the patient of the new office telephone number and address of the physician departing practice when the physician is still available in the area to attend to local patients. The physician and medical group may be subject to liability for patient abandonment should this information not be provided.

Patients should also be informed that copies of their medical records may be sent to a physician of their choice with proper consent and payment of a reasonable fee, if you choose to charge patients for copies of their record. With the closure of a practice, a flat fee for copies of any patient medical record is often set. Patients should not be given the original medical record.

For limits on what physicians may charge for copies of records see “Individual and Third-Party Access to Medical Records,” available at www.isms.org.

PLEASE NOTE: Insurance company contracts or policies may prohibit or limit billing for records. Medicare and Medicaid do not pay for records. Physicians are generally limited to a $20 witness fee for workers’ compensation records, although this rate may be negotiable.

In addition to individual letters, it is quite common for retiring or relocating physicians to announce the closure of their medical practice in local newspapers and other local media outlets. This publication can be used to satisfy the statutory notice requirement mentioned earlier. A copy of a draft notification letter and medical record authorization form are included in the last section of this booklet.

It is also advisable to post a notice on the office’s door or windows of the impending closure. This notice should include specific information regarding how to obtain copies of medical records. Additionally, the practice should update its outgoing telephone message to inform patients of the closure and process for receiving records. The practice may wish to have the mail forwarded to a P.O. Box from where it can receive and respond to requests for medical records.

If a departing physician is prevented from individually notifying patients of his or her departure, then the physician should take steps to notify patients generally, for example by publication in a local newspaper. Such notice may appear in print or online editions of newspapers, and should run for 30 days. For practices that have multiple locations, or for physicians who practice in multiple locations, notice should be given to each local community. Additional notice should be placed on the office’s website, patient portal, and in email communications, if utilized.

Medical Records Retention

When notifying patients of the physician’s departure from a medical practice or its closure, patients should be informed where to get copies of their records. Patients should also be provided a date by which they must respond to the notification letter or advertisement. Illinois does not have a statute of limitations on retaining physician office records.

It is appropriate to retain medical records for that period which would be the longest statute of limitations for a lawsuit to be filed. In most instances for adult patients that would be four years. If the record is of an adult patient, the four-year period should begin to run from the time that the patient ceases being a patient (from the last patient encounter). X-rays, and Medicaid records must be kept at least five years, and mammograms must be kept at least five years, but not less than 10 years if no subsequent mammograms of such patient

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https://www.isms.org/Login.aspx?RTN=/Resources/Members/Legal/Individual_and_Third-Party_Access_to_Medical_Records/

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are performed at the facility. Thus for adult patients, the general record retention standard is five years. Medicare records should be retained for at least seven years. Please note that written contractual obligations may be enforced for up to 10 years.

If the record is for a pediatric (minor) patient, the minimum record retention period is eight years from the last patient encounter. However, a minor patient may bring a cause of action against a physician until the patient’s 22nd birthday. Immunization records however must be kept indefinitely.

Because medical records are increasingly relied upon for financial reasons, ISMS recommends that adult patient medical records be retained for 10 years from the last patient encounter. Regarding minors, the medical records should be retained for the longer of 10 years from the last patient visit or until they turn 22. Finally, no statute of limitation exists for patients with legal disabilities. The statute of limitations does not begin to run until the disability is removed. Additionally, if the person is not under a legal disability at the time the cause of action accrues, but becomes under a legal disability before the period of limitations runs, the period of limitations is stayed until the disability is removed. For more detailed record retention information, see A Physician’s Guide to Medical Record Access and Retention, available at www.isms.org.

Remember, a physician’s medical records will be required if a medical liability case is filed against the physician or his or her estate. This may be in the form of a summons directed to the physician or estate or custodian of the physician’s records. Note that the records of unusual or adverse cases should be maintained indefinitely. The record itself includes medical records, but also patient account records, such as invoices, cash receipts, superbills, and explanation of benefits (EOB) correspondence. Other records that require maintenance include tax documents, appointment books and personnel records. For instance, IRS records should be maintained for three to seven years, but individuals suspected of fraud may be investigated at any time.

In Illinois, medical records are the property of the physician, not the patient. By law, you are required to comply with an authorized written request for patient medical records from a patient, physician, or an attorney requesting the medical records on behalf of the patient. Such requests must be honored within 30 days. If the request cannot be honored within 30 days, then you must provide a written explanation why it cannot be honored

and the request must be honored within 60 days. You are not permitted to withhold medical records because a patient fails to pay for services. All patient records must be handled confidentially to prevent unlawful disclosure of information. When a physician leaves a medical group or practice, possession of patient medical records may be handled in any manner that the physicians decide appropriate, provided the following results:

• The existing practice knows what records it has and what records it does not have.

• The physician leaving knows what records he or she has and what records he or she does not have.

• Both the existing practice and the physician who is leaving have access to all records that were once part of the practice, allowing them to respond to any request from a patient, any Medicare, Medicaid or insurance audit, professional liability claim, or other form of outside review.

In the case of physicians who depart from a practice, they must come to an agreement with the practice regarding who has control and ownership of the medical records.

The physical location of the patient’s medical records does not matter as long as all those involved know where the records are and how to access them if necessary.

Records may be electronically or physically stored. If physically stored, put them in a dry and secure location to ensure they are not compromised.

For practices that utilized electronic health records, they must ensure access to the records after departure from or closure of a practice. The records must be maintained in a manner that ensures the integrity of the records and that audit trails with metadata are retained. Practices must generally pay a fee to continue to have such access.

After the retention period for medical records has lapsed, the medical records may be destroyed in any manner that makes them illegible, such as shredding or burning. Electronic medical records must also be rendered unusable, unreadable, or indecipherable and cleared, purged, or destroyed consistent with National Institute of Technology and Standards Special Publication 800-88. Retain a log showing where each record copy was sent, and retain all written authorizations.

https://www.isms.org/Resources/Members/Legal/A_Physician_s_Guide_to_Medical_Records_Access_and_Retention/

https://www.isms.org/Resources/Members/Legal/A_Physician_s_Guide_to_Medical_Records_Access_and_Retention/

http://www.isms.org


5

Physician Licenses and Prescription PadsGenerally, two licenses are involved in the practice of medicine in Illinois:

A. Medical License - issued by the IDFPR, which permits the physician to practice medicine.

B. Illinois Controlled Substance License - also issued by IDFPR, which permits the physician to prescribe controlled substances.

At the time a physician applies for the controlled substance license, the physician also applies for a Federal Drug Enforcement Administration (DEA) number. This is issued by the DEA, following IDFPR’s approval of an Illinois controlled substance license.

Prior to closure of a practice or following a physician’s death, the IDFPR and DEA should be notified in writing. No changes in the physician’s medical license are necessary upon retirement, relocation or departure. Any change to a physician’s profile as it appears on the IDFPR website should be submitted within 60 days of the change. However, Illinois controlled substances licenses are location specific, and must be reissued for any new practice location after departure. The DEA should be notified as soon as the change occurs to request a modification of registration, which is handled in the same manner as a new application and must be approved by the DEA. Upon notification of a physician’s death, IDFPR will retire the physician’s Illinois licenses.

It is suggested that all regular prescription pads be destroyed in any manner that makes them illegible, such as shredding or burning. In addition, wall licenses provided by IDFPR to the physician to display in the office and diplomas, certificates and membership plaques should be stored in a secure location. These actions will prevent unauthorized and illegal use of the physician’s licenses and prescription supplies. IDFPR is located at 320 West Washington, 3rd Floor, Springfield, Illinois 62786, 217-785-0820. The IDFPR office in Chicago is located at 100 W. Randolph, 9th Floor, Chicago, Illinois, 60601, 1-888-473-4858.

Medications, Supplies, and BooksUpon closure of a physician’s practice, all drugs should be disposed of properly to prevent harm and to comply with state and federal laws. This usually entails disposing of prescription drugs in ways least likely to permit access to such drugs by unauthorized persons. For disposal of controlled substances, federal rules require notification of the Federal Drug Enforcement Agency (DEA) prior to disposal of controlled substances in a specific manner. DEA, 230 South Dearborn, Suite 1200, Chicago, IL 60604, 312-353-7875.

Non-controlled drugs may be destroyed in any appropriate manner. Small quantities can be crushed and flushed down the toilet. Local pharmacies, clinics or hospitals may be willing to help dispose or purchase large quantities of drugs, but not drug samples. Appropriate methods of disposal of medication may be found on the Food and Drug Administration (FDA) website at www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm. The State of Illinois also provides guidance at www.epa.state.il.us/medication-disposal/. See also “Tips for Safe Medication Disposal,” available at www.isms.org/MedicationDisposal.

If the practice is being sold, it may be possible to include the drugs in the purchase price.

Another alternative would be to donate drugs, samples, books and other supplies and equipment to charitable institutions and organizations such as free medical clinics. Your donation may be tax deductible. For example, these organizations accept donations:

The International Book Project1440 Delaware Ave., Lexington, Kentucky 40505859-254-6771 www.intlbookproject.org Mercy Ships InternationalP.O. Box 2020Lindale, Texas 75771800-772-7447 www.mercyships.org

Direct Relief International27 S. La Patera LaneSanta Barbara, CA 93117805-964-4767 www.directrelief.org

This is for educational purposes and is not intended as nor should be considered legal advice©2014 Illinois State Medical Society

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/Safe



http://www.epa.state.il.us/medication-disposal/

http://www.epa.state.il.us/medication-disposal/

www.isms.org/MedicationDisposal

http://www.intlbookproject.org

http://www.mercyships.org

http://www.directrelief.org


6

Physician Professional Liability Insurance It is necessary to notify the insurance company of the departure from, or closure of, the medical practice for any reason. In the case of a physician’s death, a refund of any unused premium may be requested. The insurer will need the date of the physician’s death and the address where you or the executor can be reached.

In addition, under current Illinois law, if a physician’s estate is handled (as required by law) with the filing of all appropriate notices, that estate may not be sued after the date that the estate is closed, unless there is liability insurance to cover the lawsuit. Therefore, it is important to maintain liability coverage until the estate is formally closed. See 755 ILCS 5/18-12.

Most physicians who are not self-insured or insured by their employer have an insurance policy or contract that provides either "occurrence" or "claims-made" medical professional liability insurance to protect them from claims and lawsuits that arise out of their medical practice.

An "occurrence" policy covers claims and lawsuits which occurred when the policy was in effect, even if the claim or lawsuit is filed many years later. Most policies extend protection to a physician’s estate. However, the policy documents should be read, or the insurance agent or company contacted to be certain that the estate is covered after the physician’s death.

Because an "occurrence" type policy covers the period of the physician’s practice, there is no need to take action at the time the practice is closed. However, if the practice is to be continued for a period of time while arrangements are made for its sale, it is necessary to call the insurer and arrange for coverage for the physician(s) who are maintaining the practice.

A "claims-made" medical professional liability policy covers only those claims and lawsuits that are actually filed during the time the policy is in effect, regardless of the date when the alleged malpractice occurred. Thus, if the physician has a claims-made policy covering the year 2014 and a lawsuit is filed during 2014 based on care delivered during that year, the policy would cover the claim.

However, if the physician had insurance in 2014 but dropped the policy and a lawsuit was filed in 2015 for care rendered in 2014, the claim would not be covered by the claims-made policy, unless the physician also had a "reporting endorsement" or "tail" coverage.

"Tail" coverage provides protection for all claims and lawsuits filed in subsequent years after the claims-made policy was ended. Essentially, it makes a claims-made policy into an occurrence policy.

Most reputable claims-made medical professional insurance companies will automatically, and at no cost, provide tail coverage when the insured physician dies or becomes permanently disabled. However, the estate should determine whether the tail coverage is for an unlimited period, or only offered for a short period of time. For other physicians, tail coverage may often be purchased. Most physicians who relocate or retire upon closure of a medical practice should obtain tail coverage. It is best practice to contact your insurance carrier immediately upon physician death, disability, or when considering selling or departing a practice. Premiums may be based on the location where you practice.

Selling the Medical PracticeMany medical practices are sold to other physicians when the owning physician wants to retire or change practices. The terms and conditions of sale are individual and specific to the practice involved. Generally, the purchasing physician, group, or health care entity will acquire all



tangible assets. With respect to a deceased physician’s practice, a fast sale of the practice will give back a larger value than a sale 6-10 months later. You quickly lose the goodwill and loyalty of patients.

Do not try to sell the practice without professional assistance of an attorney and accountant. Certain management consultants have made evaluation of medical practices a specialty, so you should consider trying to find such a professional.

Practices tend not to be sold piecemeal, but as a whole. The practice is made up of a collection of assets: equipment and furniture, improvements to the property, accounts receivable, land, supplies and medications, and medical records. Among these items, note that the value of used equipment and furniture is quite limited, unless made part of a package, and the sale of accounts receivable may be prohibited under state law. Arrangements can be made for the purchasing physician to receive a collection fee for collecting accounts receivable. What must be avoided is illegal fee splitting.

In addition, while the medical records of patients may be part of the package, understand that until a patient agrees to see the purchasing physician as his or her personal physician, the purchasing physician is merely the custodian of the records. Patient information contained in a record is confidential and cannot be viewed or used by a physician without the patient’s consent.

If medical records are included in the sale of the practice, then the selling physician should require a written agreement authorizing access to these records by the treating physician should access be necessary because of litigation, third-party payor inquiries or any other reason.

Advertisements can be placed in local, state and national medical and specialty society publications. In addition, consider notifying hospitals, clinics, medical schools and residency programs in the physician’s specialty.

Dissolution of a Medical CorporationThe closure of a corporation is a fairly complex matter, and the information presented here should not be considered an exhaustive discussion of such a situation. However, the points covered are relevant and will enable the affected individual to discuss this situation with their legal counsel in a more informed and intelligent fashion. Some of these matters can be attended to by the individual, but this will require cooperation with either legal counsel or the appropriate accounting representative.

The following material covers, in very general terms, a number of items pertaining to the closure of a professional corporation. These items should be examined by either the physician who has operated as a shareholder of the corporation or the surviving spouse of such an individual.

A. Immediately contact the insurance agent representing the corporation to ensure that both corporate liability policies and personal liability policies are providing adequate coverage for the period after termination. The situation will vary somewhat, depending on the type of insurance carried. (See section on " Physician Professional Liability Insurance.”)

B. Contact the corporation’s attorney and accountant in order to discuss economic, tax and timely considerations attendant to various forms of corporate liquidation. There are a variety of different types of corporate liquidations, and each one carries certain advantages and disadvantages. These various paths must be considered in each individual situation.

C. Discuss with the attorney and accountant the tax considerations attendant to the various forms of distribution of any retirement plans sponsored by the corporation. This examination should include income tax consequences, state tax consequences, and potential cash needs.

D. The attorney should be consulted with respect to the various legal requirements that must be satisfied in order to successfully terminate the retirement plan and to adequately treat the rights of all plan participants.

E. The physician’s employment contracts should be examined with the attorney. There are certain benefits, such as one-time lump sum death benefits, disability, and severance pay, which may be utilized to obtain favorable tax or economic treatment.

F. There are a number of elements in the liquidation process other than tax concerns that should be attended to by the client and attorney. These include, but are not limited to, notifications of various agencies such as the Secretary of State, Illinois Department of Financial and Professional Regulation, Division of Professional Regulation, and the County Recorder of Deeds that the termination is occurring. Continued page 8



G. The client and the attorney should examine any

ongoing contracts between the corporation or the physician and a third party including healthcare plans. Steps must probably be taken in order to realize any benefits or terminate any obligations created by these agreements.

H. Successfully collecting any existing accounts receivable may prove to be a difficult matter. There are a number of alternatives available, and each should be discussed with both the attorney and accountant.

I. The attorney should be consulted with respect to notifying patients of the termination of the practice and the corporation. Additionally, the attorney may advise that the corporation’s creditors or other persons or entities should be notified of the termination.

J. If a physician or the professional corporation owned a medical building, attention must be directed to either leasing or selling it.

K. Any equipment or supplies owned by the corporation must be sold or disposed of in some other fashion. There are other significant financial considerations in the disposal of such equipment.

The above mentioned items provide a brief outline of topics to be considered in the dissolution of a professional corporation. It cannot be too strongly emphasized that in such a situation, one has great need for both legal counsel and also the advice of accountants.

It often takes many months to satisfactorily terminate such a corporation, and close attention to detail is critical to ensure that all items are considered and dealt with in an appropriate manner.

Steps to Take Following a Physician’s DeathThe unexpected death of a physician will leave the surviving spouse or family with a large number of personal and financial tasks needing attention. However, there is an additional burden: contending with the needs of patients, some of whom have been dependent on the physician for years, and others who are presently in hospitals or nursing homes.

Planning for the disposition and transfer of patients and their records must be carefully considered. In addition, the spouse or executor must maintain basic activities of the practice, while at the same time protecting the practice from persons who might take advantage of the situation.

There are some things that need to be done quickly after a physician dies, and others which need to take place in the weeks and months that follow.

A. Actions to Be Taken Immediately Listed below is a sample of the activities that should be done immediately after the physician’s death (check and date when completed):

o Date:________________ Ask a colleague who has provided coverage in the

past to cover the practice for a period of time to ease immediate patient needs.

o Date:________________ Notify the office manager, receptionist and

answering service. Keep at least one key employee on at full salary to open mail, respond to inquiries, handle collection duties, etc. Find out if there are patients in the physician’s hospitals or nursing homes, who they are and how to contact them or their families.

o Date:________________ Notify the attorney, accountant, management

consultant, etc. who have served the practice.

o Date:________________ Put a sign on the office door, with a referring phone

number to prevent patients from contacting you at home, while helping them get the information or service needed.

o Date:________________ Send a death notice to the local newspaper.

Continued from page 7



o Date:________________ The medical staffs of all hospitals and other facilities

where the physician had membership and privileges should be notified, usually by writing or calling the facility administrator or medical staff secretary. The Chief of Staff may designate another physician to provide coverage for the deceased physician’s hospitalized patients.

o Date:________________ Contact patients who may be in hospitals or nursing

homes where the physician had privileges, and inform them who is covering the practice and who can answer requests for information and assistance.

o Date:________________ Local pharmacies should be informed so no one can

use the physician’s name to obtain drugs illegally.

o Date:________________ HMOs, PPOs, schools and any other organization

where the physician may have had contracts or was employed should be notified.

o Date:________________ The physician’s medical professional liability carrier

should be contacted, and if he had “claims-made” insurance, determine if he requires “tail” coverage. (A description of this subject is on page six.)

o Date:________________ One should also notify the insurance agents that

have provided the physician with liability, disability, health, etc. coverage on both the office and any other facilities. Certain coverages may need to be activated or maintained for a certain period of time.

o Date:________________ Notice should be placed on the practice’s website

and patient portal regarding the death.

B. Actions to Be Taken in the Weeks Following

The following activities should take place within the month following the physician’s death (check and date when completed):

o Date:________________ Draft a form letter to active patients notifying them

of the physician’s death and provide information on who is providing coverage and how they can obtain copies of their records. Request patients send an authorization form for any transfer of records.

o Date:________________ Have furniture and equipment appraised for

possible sale.

o Date:________________ Begin collection action on outstanding accounts

receivable.

o Date:________________ Notify suppliers of the office, and ask for final

statements. Pay any outstanding bills.

o Date:________________ Meet with the accountant and attorney. You must

determine what steps need to be taken to protect the physician’s estate and how to deal with tax matters, Keogh or pension plans, employee salaries, payroll records, etc.

o Date:________________ Notify landlord for termination of lease, if appropriate.

o Date:________________ Notify utilities and telephone about discontinuing

service after a certain date, generally 60 days.

o Date:________________ Securely store or destroy diplomas, licenses and

medical certificates.

o Date:________________ County/state/national medical and specialty societies

where the doctor had memberships should be notified of the physician’s death.

o Date:________________ Major third-party payers should be notified, including

Medicare and Medicaid.

o Date:________________ Notify the Post Office to ensure that all mail,

especially checks, are forwarded.

o Date:________________ As a matter of courtesy, notify other physicians who

were closely associated with the physician.

The spouse or executor must maintain basic activities of the practice, while at the same time protecting the practice from persons who might take advantage of the situation.



C. State and Federal Agencies to Be Contacted

o Date:________________ The Illinois Department of Financial and

Professional Regulation, Division of Professional Regulation (IDFPR) grants physicians their medical and controlled substance licenses.

IDFPR 320 West Washington Springfield, Illinois 62786, (217) 785-0820

The IDFPR office in Chicago is located at 100 W. Randolph, 9th Floor Chicago, Illinois, 60601 1-888-473-4858 http://www.idfpr.com/DPRdefault.asp

o Date:________________ The Illinois Department of Healthcare and Family

Services (formerly Public Aid) handles Medicaid reimbursement.

HFS 201 South Grand Avenue East Springfield, IL 62763-0001 (217) 782-1200 http://www2.illinois.gov/hfs/Pages/default.aspx

o Date:________________ The Federal Drug Enforcement Administration

(DEA) grants federal controlled substance licenses. DEA 230 South Dearborn, Suite 1200 Chicago, IL 60604 (312) 353-7875.

o Date:________________ (In addition, the physician may have had working

agreements with the Illinois Department of Human Services and other agencies.)

Once again, this list may not include all those who need to be contacted. Ask the physician’s employees and colleagues for assistance if you don’t have a list to work from.

NOTES:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

http://www.idfpr.com/DPRdefault.asp

http://www2.illinois.gov/hfs/Pages/default.aspx



Following is a list of persons, organizations, agencies, and information important to a physician’s practice. This list should be completed by the physician and updated regularly (use pencil to facilitate changes).

A. Name, address and phone number of:

o Date:________________ Accountant(s): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Answering service:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Attorney(s):_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Covering and/or referral physician(s):__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Funeral director, location of cemetery plot, plot number and deed: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Insurance agent:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Management consultant:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Office manager:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Receptionist:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Stock broker: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Trust officer:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Other people involved with the financial and administrative management of the medical practice:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix A Checklist


B. The location of:

o Date:________________ Last executed will:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Trust agreements:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Codicils and other legal documents involving the practice and family:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Lockbox keys or safe combinations:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ A listing of account numbers of personal and business checking and savings accounts:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________o Date:________________ A listing of numbers of life and other insurance policies:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Deeds and mortgage papers of home, office and any other applicable real estate contracts, leases or rental agreements: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Birth and marriage certificates, citizenship papers, adoption papers, military discharge papers, Veterans Administration number, Social Security numbers, and other personal data: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Stock and bond securities, other investments and cost figures:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Unpaid personal bills or obligations:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ A list of credit card numbers: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ The physician’s taxpayer identification number:______________________________________________________________________________________________________________________________________________________

Appendix A Checklist continured



o Date:________________ Names and addresses, Social Security numbers for each office employee:________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Records of accounts receivable and payable:___________________________________________________________________________________________________________________________________________________________

o Date:________________ Tax information for federal, state and local taxes:___________________________________________________________________________________________________________________________________________________

o Date:________________ A list of hospitals, clinics, nursing homes, etc., where physician practices:__________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ A list of all associations and organizations where the physician holds membership:_______________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ A list of the state licensure agency, Medicaid, and Medicare agencies:__________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ All narcotics, drug records, tax stamp, etc.:______________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ A list of suppliers of office equipment and materials. (Have information, purchase price and date of major office equipment and likely sales outlets):_______________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Receipts, unbanked cash:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Other:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Other:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Other:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o Date:________________ Other:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix A Checklist continured


SAMPLE PRACTICE CLOSURE LETTER:PATIENT NOTIFICATION (PHYSICIAN RETIREMENT OR CLOSURE)

Dear ____________________________________

I appreciate the trust you have shown in allowing me to provide for your medical needs.

At this time I am writing to announce the closure of my medical practice. [OPTIONAL: I am retiring after many years of practicing medicine.]

My practice will close for patient appointments on ______________(date). No medical services may be provided after that date.

I recommend that you arrange for care with another physician. You may want to contact the county medical society, a local hospital or your health care plan for a referral.

Should you want another physician to have a copy of your medical records, please fill out the attached authorization form and return it to my office no later than _____________(date). The office will be open until__________(date) for patients to pick up medical records. You can stop by between the hours of_________________(days and hours) to receive a copy of your medical records. After this date, all requests for medical records should be sent to_____________________________________(address and/or email address).

If you need medical care prior to the closure of my practice listed above, please do not hesitate to contact my office or the Emergency Department at _________________Hospital at [hospital telephone #]. My desire is that the closure of my practice be as easy on you as possible. Once again, I am grateful for the opportunity to have been your physician.

Very truly yours,

____________________________________, M.D.

Appendix B



Appendix C

SAMPLE PRACTICE CLOSURE LETTER:PATIENT NOTIFICATION (PHYSICIAN DEPARTURE)

Dear ____________________________________

I appreciate the trust you have shown in allowing me to provide for your medical needs.

At this time I am writing to announce my departure from [PRACTICE NAME] effective [DATE]. After that date, I will no longer be seeing patients at this practice. [OPTIONAL: IF PERMITTED THROUGH NONCOMPETE AGREEMENT, PROVIDE NEW PRACTICE LOCATION].

I recommend that you arrange for care with another physician within [PRACTICE NAME]. Additionally, you may want to contact the county medical society, a local hospital or your health care plan for a referral.

Should you want another physician to have a copy of your medical records, please fill out the attached authorization form and return it to [PRACTICE NAME].

If you need medical care prior to the closure of my practice listed above, please do not hesitate to contact my office or the Emergency Department at_________________Hospital at [hospital telephone #]. My desire is that my departure from the practice be as easy on you as possible. Once again, I am grateful for the opportunity to have been your physician.

Very truly yours,

____________________________________, M.D.


SAMPLE PRACTICE CLOSURE LETTER:PATIENT NOTIFICATION (PHYSICIAN DEATH)

Dear ____________________________________

We appreciate the trust you have shown in allowing Dr. ______________ to provide for your medical needs.

At this time I am writing to inform you of the unfortunate death of Dr. _______________. With the physician’s death, Dr. _________________ will be attending to patients at the medical practice until_________________. [ALTERNATIVE: With the physician’s death the medical practice has closed.]

Should you want another physician to have a copy of your medical records, please fill out the attached authorization form and return it to the office no later than _____________(date). [IF CLOSING OFFICE: The office will be open until_______________(date) for patients to pick up medical records. You can stop by between the hours of_______________(days and hours) to receive a copy of your medical records. After this date, all requests for medical records should be sent to_______________________________________(address and/or email address).]

If you need immediate medical care, please do not hesitate to contact the Emergency Department at _________________Hospital at [hospital telephone #] [ ALTERNATIVE: or the office _________________]. We hope that the closure of the practice will be as easy on you as possible.

Once again we are grateful for the opportunity for Dr. ________________to have been your physician.

Very truly yours,

_____________________________________, M.D.

Appendix D



Appendix E

Model Authorization for Release of Confidential Health Information

Authorization for Release of Confidential Health Information

Patient name:__________________________________ Telephone:__________________________________ Address:_______________________________________ Date of birth:________________________________ City/State/Zip:__________________________________ Medical record # (office only):_________________ I hereby authorize the protected health information regarding the above-named person to be exchanged to:Person/Institution/Other:_________________________________________________________________________________Address:_______________________________________________________________________________________________City/State/Zip: __________________________________________________________________________________________Phone number:__________________________________________________________________________________________ I authorize the release of information pertaining to the following time periods:From date(s): To date(s):

The following types of information to be disclosed are as follows: o History and physical examination o Abstract (documents summarizing history) o Consultation reports o Diagnostic reports (labs, x-rays, etc) o Progress notes o X-ray films o Operative reports o Other: The following highly CONFIDENTIAL items must be checked off to be included in the disclosure: o HIV/AIDS related health information/records (410 ILCS 305/9) o Behavioral or mental health information/records (740 ILCS 110/1 et seq) o Drug/alcohol diagnosis, treatment, referral information (20 ILCS 301/30.5; 42 CFR Pt. 2) o Genetic testing information/records (410 ILCS 513/30) The purpose(s) of this authorization is (are): ______________________________________________________________

This authorization expires (date):_______________________. If not specified, this release will expire one year after the date of signature:_______________________ .[date]

Continued page 18

18 This is for educational purposes and is not intended as nor should be considered legal advice

• I understand that I have the right to inspect and copy the information I have authorized to be disclosed by this authorization. In the event I refuse to authorize the release of the above-described information, I understand that it will not be disclosed, except as provided by law.

• I understand that the practice may not condition treatment on whether I sign this authorization, except when the provision of health care is solely for the purpose of creating protected health information for disclosure to a third party.

• I understand that information used or disclosed pursuant to this authorization may be subject to redisclosure by the recipient and may no longer be protected by law.

• I understand that this authorization is valid until it expires, unless revoked before that.

• I understand that I may revoke this authorization at any time by giving written notice to the physician of my desire to do so. I also understand that I will not be able to revoke this authorization in cases where the physician has already relied on it to use or disclosure my health information. Written revocation must be sent to the physician’s office.

• I have read and understood the terms of this Authorization and I have had the opportunity to ask questions about the use and disclosure of my health information. By my signature, I knowingly and voluntarily authorize [insert practice or physician name] to use or disclose my health information in the manner described above.

Printed name of patient, legal guardian, or authorized agent:________________________________________________

Signature of patient or legal guardian, or authorized agent:__________________________________________________

Date:____________________________________________ Relationship to patient: __________________________ Staff signature:___________________________________ Date: ___________________________________________

Model Authorization for Release of Confidential Health Information continued

(To verify signer’s identity)

www.isms.org

Illinois State Medical Society(Chicago office)20 North Michigan Ave., Ste. 700Chicago, Illinois 60602

800-782-4767

llinois State Medical Society(Springfield office)600 South Second St., Ste. 200Springfield, Illinois 62704

800-782-4767

Illinois State Medical Society

Appendix E continured

14-2179-S

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