10/23/2018
NOTICE OF RETIREMENT (DEC 2018)
Donald A. Morris, M.D.
136 East 64th St.
New York, N.Y. 10065
(212) 688-6060
Dear Patients,
After 50 years in practice, I am writing to inform you that I will be retiring from my practice of Ophthalmology on December 20, 2018. I will be available to serve your medical needs until that date.
Upon my retirement, my friend and colleague, Dr. Peter Berglas, has agreed to assume my practice, and your medical records will be maintained at his office, which is located in the same building in which I have practiced for so many years, 136 East 64th St. Since these records are confidential, Dr. Berglas will hold these records for safekeeping purposes, and will have access to them only with your consent. Your records will be kept for 10 years after your last visit. I have great confidence in the ability of Dr. Berglas, a well-trained board certified ophthalmologist, to meet your ophthalmological needs. He accepts Medicare and most commercial insurance. His office can be reached at (212) 744-6800.
Should you prefer copies of your records be sent to another ophthalmologist, it is required that we obtain your written authorization, in order to make them available to that physician. For this reason, I am including at the end of this letter an authorization form which you can sign and return to my office by December 20, 2018, or Dr. Berglas’s office in 2019.
I am extremely grateful that you chose me to be your ophthalmologist. I extend to you my best wishes for the health and happiness of you and your family.
Very truly yours,
Donald A. Morris, M.D.
_____________________________________________
AUTHORIZATION TO TRANSFER RECORDS
Date____________
To: Dr.__________________________
I hereby authorize you to transfer or make available
to_______________________M.D.
at___________________________________________
(address)
a copy of the records and reports relating to my ophthalmological treatment.
_____________________
Patient name (please print)
_____________________
Patient signature
_____________________
Date of Birth
