Structured referral letter template for inter-specialty and GP referrals.
Referral notes communicate the clinical need for specialist input, providing sufficient background for the receiving clinician to triage and manage the referral appropriately.
CLINICAL REFERRAL ===================================== DATE: _________________________________ URGENCY: Routine / Urgent / Same-day TO: ___________________________________ Specialty: ____________________________ Hospital: _____________________________ FROM: _________________________________ Grade: ________________________________ Contact: ______________________________ Bleep/Phone: __________________________ PATIENT: ______________________________ DOB: _____________ NHS No: ____________ GP: ___________________________________ REASON FOR REFERRAL: [Clear statement of the clinical question] HISTORY: [Relevant background] EXAMINATION: [Relevant findings] CURRENT MEDICATIONS: 1. 2. ALLERGIES: ____________________________ INVESTIGATIONS: [Relevant results] SPECIFIC REQUEST: [What you need from the receiving team] Thank you for seeing this patient. SIGNATURE: ____________ DATE: _________ NAME (print): __________________________ GMC/NMC No: ___________________________