Patient Decline Services

Date

 

Patient Name
Patient ID

 

Dear Provider,

We have received your referral and contacted your patient regarding the Lung Nodule Program.

Unfortunately, your patient has declined services at this time.  Please let us know if we can be of assistance in the future.

If you have any questions or need more information, please feel free to contact one of our Patient Navigators at (XXX) XXX-XXXX.

Thank you for your consideration. We at XXXXX believe that screening and early detection are an integral part of caring for your patients and making our communities healthier

 

Sincerely,
Your Lung Cancer Screening Team