Referral Letter

Purpose: This document serves as a formal letter of referral from a primary care physician or healthcare provider to a specialist, requesting further evaluation and management of the patient's condition.

From: Dr. {referringDoctorName}, {referringDoctorTitle}
Clinic: {clinicName}
Address: {clinicAddress}
Phone: {clinicPhone}

To: {specialistName}
Specialty: {specialty}
Facility: {specialistClinicName}

Date: {date}

Patient Information

Medical History / Reason for Referral

I am referring {fullName} for further evaluation and possible management regarding the following concern(s):

{reasonForReferral}

{#hasMedicalHistory}

Relevant Medical History:

• {medicalHistoryDetails}

{/hasMedicalHistory}

Current Medications:

{#medications}

• {name} - {dosage}, {frequency}

{/medications}

Investigations and Attachments

{#hasInvestigations}

• {investigationType}: {details}

{/hasInvestigations}

{^hasInvestigations}There are no investigations to report at this time.{/hasInvestigations}

Requested Assessment/Treatment

{requestedAssessment}

If you require any additional details, please do not hesitate to contact my office. I appreciate your time and expertise in evaluating and managing this patient's condition.

Sincerely,
Dr. {referringDoctorName}
{referringDoctorTitle}
{clinicName}