This document provides guidance on writing effective referral letters. It outlines the key components that should be included in a referral letter such as patient demographic information, history of present illness, past medical history, medications, physical exam findings, investigations, clinical impressions, and expectations for the referral. Referral letters are the primary means of communication between physicians when a patient is being referred to a specialist or other provider. A clear, concise referral letter helps ensure continuity of care and avoids issues like delayed diagnosis, unnecessary testing, or patient dissatisfaction. The document emphasizes that referral letters require practice to write effectively and provides examples of content that should be included.

1. PRESENTER
DR. A.F.M. SHAKILUR RAHMAN
OSD (DGHS)
DEPT. OF ORAL & MAXILLOFACIAL
SURGERY(ATTACHMENT)
DHAKA DENTAL COLLEGE & HOSPITAL.

2. Referral Letter For
Medical Purposes

3. INTRODUCTION
 Effective communication is essential for an efficient, high
quality of referral process.
 With the move to providing more patient care there is
now often little face-to-face contact between primary care
and specialist physicians & surgeons.
 As a result, written communication, in the form of referral
request and reply letters, is the most common means by
which doctors exchange information relevant to patient
care (Tattersall et al, 1995).

4. CONTINUED-
 A referral involves sending a patient for the ongoing
management of a specific problem with the expectation
that the patient will continue to see the original
physician/surgeon for the overall coordination of care
(Nutting et al, 1992).
 Referral of patients to hospitals, specialists and other
institutions is an essential part of health care.
 Referral and reply letters are the means of
communication between doctors.

5. CONTINUED-
• Breakdown in communication could lead to poor
continuity of care, delayed diagnoses, polypharmacy,
and unnecessary testing. (Epstein, 1995; Gandhi et
al, 2000)
• Referral has considerable implications for patients, health
care system and health care costs.
• Patients are referred to specialists when investigation or
therapeutic options are exhausted in primary care or
when opinion or advice is needed from them.
 A referral letter also helps to avoid patient dissatisfaction
and loss of confidence.

6. Indications-
1. Routine (cataract)
2. Urgent (iritis)
3. Emergency (acute glaucoma).

7. Intention of the referral
1. Opinion
2. Advice
3. Investigations
4. Treatment
5. Admission

8. How best to write a referral letter
 Be clear and concise, especially with emergency
referrals.
 Explain why the referral is needed.
 Use detail history and investigations and highlight
relevant information.
 If you are unclear of the diagnosis, tell the specialist
what you want from them, providing your differential
diagnoses.
 Writing referral letters will requires practice. Consult
your colleagues and take time to learn the art.

9. Contents of referral letter
1. Demographic data: All letters should include
relevant patient’s name, sex, date of birth, full
address.
2. Initial statement outlining reason for referral: A
single sentence introduction including gender,
age, and problem/reason for consultation helps the
reader in more efficiently processing subsequent
information.
3. History of the presenting problem: Description of
the chief complaint, associated symptoms and
relevant collateral history.

10. Continued-
4. Past history: Letters should include summaries of
medical, surgical, and, if relevant, of obstetrical
histories.
5. Psychosocial history: Letters should include
relevant family, work and travel histories as well as
habits depending on the presenting problem.
6. Medications: All letters should include an upto-
date medication list which includes over-the-
counter and herbal products.
7. Allergies: Should list the presence (or absence) of
allergies.

11. Continued-
8. Physical findings- Relevant clinical findings
9. Investigations- List all laboratory/imaging
investigations done .Copies of original reports should
be attached.
10. Clinical impressions-
11. Outline expectations- The reason for the
consultation and the referring physician’s
expectation(s) should be clearly stated in the letter.
Specific expectations regarding return of the patient
(opinion only or transfer) and the urgency of the
consultation should also be clearly stated.

13. References-
 1. Tattersall, M.H.N., Griffin, A., Dunn, S.M., Scatchard, K. & Butow, P.N.
1995, ‘Writing to referring doctors after a new patient consultation: What is
wanted and what was contained in letters from one medical oncologist?’
Australian & New Zealand Journal of Medicine, vol. 25, pp. 479-482.
 2. Nutting, P., Franks, P., Clancy C. 1992, ‘Referral and consultation in
primary care: Do we understand what we are doing?’ Journal of Family
Practice, vol. 35, no. 1, pp. 21-23.
 3. Structured Printed Referral Letter; Saves Time and Improves
Communication, Journal of family care medicine. 2013 Apr-Jun; 2(2): 145–
148.