Medical Referral Letter Generator

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Select Specialty: General Referral Cardiology Orthopedics Neurology Gastroenterology Dermatology Endocrinology Psychiatry Oncology Pulmonology

Referring Physician Information

Name:

Clinic/Hospital:

Phone:

Email:

Fax:

Patient Information

Full Name:

Date of Birth:

Gender: Male Female Other

Phone:

Email:

Address:

Insurance:

Insurance ID:

Referral Information

Specialist Type: Cardiologist Neurologist Orthopedist Gastroenterologist Dermatologist Endocrinologist Psychiatrist Oncologist Pulmonologist Rheumatologist Nephrologist Other (Specify)

Other Specialist:

Specialist Name (if known):

Urgency: Routine Urgent Emergency

Date of Referral:

Clinical Information

Cardiology Template

Orthopedics Template

Neurology Template

Gastroenterology Template

Dermatology Template

Chief Complaint:

History of Present Illness:

Past Medical History:

Current Medications:

Allergies:

Physical Examination Findings:

Diagnostic Test Results:

Impression/Working Diagnosis:

Reason for Referral:

Additional Notes:

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No saved templates yet. Create a referral and click "Save as Template" to save it for future use.

Help & Instructions

How to Use the Referral Generator

1. Select a specialty template from the dropdown to pre-fill relevant clinical information
2. Fill in the referring physician information
3. Enter patient details
4. Select the specialist type and urgency
5. Complete the clinical information section
6. Click "Generate Referral Letter" to create your referral
7. Print, download as PDF, or copy to clipboard
8. Save frequently used templates for future use

Tips for Effective Referrals

• Be concise but thorough in the clinical information
• Clearly state the reason for referral and any specific questions
• Include all relevant test results and current medications
• Specify the urgency of the referral
• Provide accurate contact information for both the patient and referring physician

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