Free template · PDF
Referral letter template
A referral the receiving consultant can triage from the first paragraph, with the history they would otherwise phone for.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What is on the form
- Practice letterhead, date and reference
- Patient: name, date of birth, MRN and address
- Specialist or clinic, hospital, referral date and priority
- Reason for referral
- Relevant medical history
- Current medications and allergies
- Examination and investigations
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- State the question you want answered in the first line of the reason for referral.
- Mark the priority honestly; the receiving clinic plans its list from it.
- Attach or list the results you mention, with their dates.
Less paperwork to fill in at all.
In Ask Brigid, consult dictation returns a transcript in the patient record for you to review, next to the diary and the inbox. Practice management for private consultants.
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