Referral Letter Template Medical UK

The Referral Letter Template Medical UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring customizable and printable examples.

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Online – Template

Sample

Referral Letter Template Medical UK

Editable – Printable

PDF – 1 PDF – 2

Referral Letter Template Medical UK

1. Referring Physician Information


2. Patient Information


3. Referral Details

4. Medical History

5. Current Medications

6. Examination Findings

7. Recommended Actions

8. Contact Information for Further Queries

9. Consent for Referral

10. Signatures and Agreement

11. Declaration


PDF

WORD

Examples

Referral Letter Template Medical UK (1)
From:
[Name of Referring Doctor]
[Referring Doctor’s ID]
[Practice Address]
[Practice Phone]
[Practice Email]
To:
[Name of Receiving Specialist]
[Specialist’s ID]
[Specialist’s Address]
[Specialist’s Phone]
[Specialist’s Email]
Date:
[Date]
Patient Information:
[Patient Name]
[Patient ID]
[Patient Date of Birth]
[Patient Address]
[Patient Phone]
Reason for Referral:
I am referring [Patient Name] for [specific condition or reason for referral, e.g., further evaluation and management of suspected diabetes].
Patient History:
[Provide detailed medical history, including presenting symptoms, relevant past medical history, medications, allergies, and any previous relevant investigations or treatments].
Examination Findings:
[Write any relevant examination findings that are pertinent to the referral].
Requested Actions:
I would appreciate your assessment and management of [Patient Name] and any recommendations you may have regarding their ongoing care.
Attached Documents:
[List any attached documents, such as medical records or test results].
Thank you for your attention to this matter.
Sincerely,
[Signature of Referring Doctor]
[Name of Referring Doctor]
[Referring Doctor’s Practice Name]
Referral Letter Template Medical UK (2)
From:
[Name of Referring Doctor]
[Referring Doctor’s ID]
[Practice Address]
[Practice Phone]
[Practice Email]
To:
[Name of Receiving Specialist]
[Specialist’s ID]
[Specialist’s Address]
[Specialist’s Phone]
[Specialist’s Email]
Date:
[Date]
Patient Details:
[Patient Name]
[Patient ID]
[Patient Date of Birth]
[Patient Address]
[Patient Phone]
Indication for Referral:
This letter serves as a formal referral for [Patient Name] for [clearly state the reason for referral, e.g., suspected cardiovascular disease].
Relevant Clinical History:
[Provide a comprehensive overview of the patient’s clinical history, including presenting complaints, past medical history, medications, and any other relevant details].
Physical Exam Results:
[Include any pertinent physical exam findings that may aid in the assessment].
Request for Evaluation:
Please evaluate [Patient Name] and provide your recommendations on the management of their condition. Your expertise would be greatly appreciated.
Documents Enclosed:
[Mention any relevant documents you are enclosing, such as lab results, imaging reports, or previous consultations].
Thank you for your collaboration.
Sincerely,
[Signature of Referring Doctor]
[Name of Referring Doctor]
[Referring Doctor’s Practice Name]

Printable

PDF – 1 PDF – 2

Referral Letter Template Medical UK