Risk Management Q & A: Patient Dismissal***
KHF reached out to our risk management advisor Curi regarding this topic and we wanted to share the response in case other practices find the information helpful.
Q: I have an issue with a patient that added immunizations to a 3231 after we signed it and gave it it to the school. She then asked us to write a letter that her child cannot have immunizations because of severe reactions that we have never seen. I want to get this patient dismissed but also want to make sure that we write the dismissal correctly. What should I do?
A: You can dismiss a patient for falsifying a document, so long as the patient is not in an active phase of treatment. In cases where you are not certain about the individual who may have falsified the document, it may be prudent not to provide a reason for the dismissal, as you are not required to. In these situations, providing a reason may become adversarial, and it may be best not to include it in the letter. I have attached a sample letter.
You can decline to write a letter that the child cannot have immunizations because of severe reactions that you have never seen or have not been reported to you and are not documented in the medical record. However, if the parent now reports these reactions, you should document them as being reported by the parent in the medical record. This should be documented as you would an allergy. See below for suggested elements of the documentation.
When a person presents with suspected drug allergy, document their reaction in a structured approach that includes:
- the generic and proprietary name of the drugs or vaccine suspected to have caused the reaction, including the strength and formulation
- a description of the reaction
- the date and time of the reaction
- the number of doses taken or number of days on the drug before the onset of the reaction
- the route of administration
- which drugs, drug classes, and vaccines to avoid in the future.
Click here to see additional risk management guidance on patient termination.
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