is sent from

primary care physician

A medical referral letter ( general pationtioner
specialist

diagnoson
with a request for

using a standard business letter template

&

include the date

address patient's personal information

body of the Letter referring doctor's contact information
signature reason
for the referral
patient's medical -
history

4
clinical ()
findings
prior test results (*)

any previous treatment (*)

Patient's Personal Information

Dear Doctor, 50
year old woman

I would be grateful if you would see this 50-year-old

woman who has lost 20 kilos in weight in spite of eating
more than usual. She describes herself as overactive and Patient's medical history :

at first she thought the weight loss was due to this. But no

more recently she has developed palpitations, diarrhea, Clinical

Findings
and heat intolerance. She has noticed that her hands Loss weight
heat intolerance
have a tendency to shake. overactive diarrhea
Her symptoms suggested hyperthyroidism and this was palpitation tendancy to shake
confirmed by my examination which revealed an enlarged Prior Test Results
revealed
thyroid, red sweaty palms and a fine tremor of the hyperthyroidism
>
-

hands. an en larged thyroid, ...

Thank you for seeing her.

Yours sincerely, Mary Knox
Any previous treatment

no

Dear Doctor, Patient's Personal Information

I am writing to refer to you this 60-year-old woman who female , 60-year-old
complains of tiredness and constipation. She has gained 5
kilos in the past three months although she says her Clinical Findings
appetite is poor. She has noticed that her hair has begun tiredness constipation
gained weight in spite of eat lots
to fall out and that her skin is very dry. I am wondering
Loss hair
if she is hypothyroid. skin dry
Thank you for seeing her. Yours sincerely, Prior test results
Samantha Black no

Revious treatments
no
Dear Doctor, Patient's personal infor
I am writing to refer Mr. Dawson who has walking
difficulty due to cerebrovascular accident. He requires your
advice and assistance to improve his mobility.
Patient's medical history
Mr. Dawson has had a cerebrovascular accident four years
his rehabilitation successful
ago. His rehabilitation was generally successful. However,
he still experiences speech and balance impairments along healing well
his wound

with left-sided weakness. It is important to mention that Reason for referral

he limps. Consequently, he fell at home while descending patient needs your advice assistance
stairs, which resulted in grazed left knee. Currently his to improve his mobility
wound is healing well. Therefore, he was advised to Use a
Clinical
walking stick to support his mobility, but he doesn’t know Findings
speech balance impairments
how to use it properly.
limps
In view of the above condition, please visit Mr. Dawson to
access his condition to provide necessary support. It would Prior test results
be highly appreciated if you could teach him how to use
Wo
the walking stick properly. His home address and contact
details attached to this letter.
Previous treatments
Please do not hesitate to contact me if you require further
information regarding his condition. stick
Yours sincerely,
use
walking
Peter Brown.

b
-- A

-
A

-
-

- A
Patient's personal Information

. Green
Mr , 4
years old ,
saleman

Patient's medical history

central chest pain radiating to Larm
.

started c.
severe attack dyspiece
c .

pain lasted so m relieved by pan

exertion
has occurred since on

Prior Test Results

normal
 Patient’s name: Charmine Plantz

S Age: 52

Occupation: truck driver

Sex: M

Chief complaint
Frequent urination and excessive thirst, particularly in the late afternoon and
early evening, blurred vision

&
Relevant history > medical
- history
A family history of diabetes on both his father's and mother's sides; hypertension
On Examination > high quick
Blood pressure: 140/90, Pulse: 80, Respirations: 24 and labored. Body weight 68kg.
Clubbing, cyanosis: absent
Eyes: redness of the eye lid, blurred vision

Findings
HbA1c: 9.1% (estimated average glucose: 214 mg/dL) > j hut at

Fasting blood glucose: 167 mg/dL

Two-hour glucose level (after 75 g oral glucose tolerance test): 310 mg/dL > co
-

Diagnosis
( Type 2 DiabetesI