Referral letter and reply slip
Page one is the letter you send with the patient. Page two is a reply slip the receiving doctor fills in and returns, so the referral comes back with an answer.
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- Word · English.docx · 38 KB
- PDF · English.pdf · 219 KB
- Word · Arabic.docx · 39 KB
- PDF · Arabic.pdf · 81 KB
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Rather fill it in on screen? Referral letter generator
What is on the two pages
| To and from | Receiving doctor, specialty, facility and city; referring doctor, specialty and the phone or WhatsApp for the reply. |
|---|---|
| Patient and urgency | The standard patient block and urgency: routine, soon or urgent. |
| The clinical picture | Reason for referral, relevant history and findings, investigations attached (labs, imaging, report, photos, ECG), current medications and allergies. |
| What you are asking | The specific question or requested action, and what should happen after: return to you, stay under their care, or advice only. |
| Reply slip | Seen on and by, findings, diagnosis, treatment given or planned, recommendations to the referring doctor, who follows up and when, then signature and stamp. |
How to use it
Add your letterhead
Open the Word file and put your logo and clinic details in the header box.
Ask one clear question
A referral with a specific question gets a specific answer.
Attach and tick
Tick the investigations you are sending, so the receiver knows what to expect.
Send both pages
The patient takes the letter and the reply slip; the reply comes back to the number you wrote.
Who it is for
General practitioners, family doctors and specialists who refer patients to other doctors, hospitals or imaging centres, and specialists who want a standard way to reply.
Questions
Why include a reply slip?
Most referrals never come back in writing. A ready slip with your contact details makes replying quick, and the answer goes into the patient’s file.
What is the difference between soon and urgent?
Your clinic decides. Many clinics agree time frames with the services they refer to most and write them on the form.
Can I send it by WhatsApp?
Yes. Fill in the Word file, save it as PDF and send it, with the patient’s consent to share their details.
Does the patient see the letter?
Usually, since they carry it. Write it in a way you are happy for them to read.
Referrals that come back
In Medicolize the referral is written from the patient file, the reply is filed against it, and you can see which doctors refer to you and which you refer to. Thirty minutes on your own clinic.