There are several important steps:

• Document everything the patient has or has not done which shows his/her non-compliance
• Send the patient a letter (send both regular and certified mail) explaining the treatment recommended and the importance of compliance
• You may indicate that continued non-compliance could result in termination of the physician-patient relationship

Do not terminate the relationship during an acute situation which could lead to allegations of abandonment. Send the patient a letter (both regular and certified mail) indicating your desire to terminate the relationship; your willingness to handle any emergency situations for the next 30 days; and suggestions on where to find another physician (i.e., County Medical Society). Clearly state what the patient's medical situation and needs are at this point, and let the patient know that you will be happy to furnish their new physician with a copy of the patient's medical record.

*If the patient belongs to a managed care organization, you must first check with them to determine termination protocol, if any.

These records can prove to be very important in the defense of a claim. If possible, keep them indefinitely.

This varies from state to state. Contact Risk Management Services at Professionals Advocate for guidance on this issue.

Generally, no (except in an emergency situation). See the AMA's Code of Medical Ethics Opinions 1.2.1

When the patient is an immediate family member, the physician's personal feelings may unduly influence his or her professional medical judgement. Or the physician may fail to probe sensitive areas when taking medical history or to perform intimate parts of the physical examination. Physicians my feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training. You should also not self-prescribe and you should avoid prescribing to friends and family - the Board had levied sanctions on physicians for writing prescriptions to friends and family members who aren't their patients. 

Generally, no, but it is permissible under certain circumstances - primarily for established patients on chronic medications. NO OPIOIDS under any circumstances. 

For critical comments of the practice - use a neutral, standard response ("I'm sorry to hear about your experience, please call the office to schedule a time so that we can address your concerns"). Responding to the comments with patient information could result in a HIPAA violation. 

You need to go through the appeals process with the managed care entity.Advise the patient your recommended treatment was not approved and give the patient their options (including paying for the recommended treatment themselves). Document #1 and 2.