The steps could be different for each state so check with the state Medical Society. The termination needs to be in writing and I would recommend Certified mail/Fedex/UPS, etc.
The letter needs to:
1. Inform the patient why the termination - there should have been prior discussion in the practice with the patient's disruptive behavior,.
2. Provide suggestions for the patient to obtain treatment - you may not want to provide specific doctor names but you could provide information for the medical society, insurance carrier, hospital hotlines, etc.
3. Inform the patient of the timeline (suggestion of 30 days minimum) where you will see the patient for any acute situation. The timeline could change based on the need and situation of the patient and the ability to obtain a new physician
4. Inform the patient of treatment that needs immediate type care and inform him or her of any potential consequences of failing to do so
5. Inform the patient you will provide medical records, etc. to the new provider and enclose your release of information form
Last of all, depending on the situation, you may need the advice of your healthcare attorney to make sure you do not terminate inappropriately.