Nhs Referral Letter Template UK

The NHS Referral Letter Template UK is provided in multiple formats, including PDF, Word, and Google Docs, and comes with customizable and printable samples.

Open – Template

Online – Template

Sample

Nhs Referral Letter Template UK

Editable – Printable

PDF – 1 PDF – 2

NHS Referral Letter Template UK

1. Referrer Information




2. Patient Information



3. Referral Details


4. Medical History

5. Current Medications

6. Allergies

7. Previous Treatments

8. Additional Information

9. Referrer Signature and Agreement

10. Declaration of Accuracy


PDF

WORD

Examples

NHS Referral Letter Template UK (1)
From:
[Referring Doctor’s Name]
[Medical Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]
To:
[Receiving Doctor’s Name or Department]
[Hospital Name]
[Hospital Address]
[Hospital Phone]
Date:
[Date of Referral]
Subject:
Referral for [Patient’s Full Name], [Patient’s Date of Birth]
Dear [Receiving Doctor’s Name],
Patient Information:
Name: [Patient’s Full Name]
Date of Birth: [Patient’s Date of Birth]
NHS Number: [Patient’s NHS Number]
Address: [Patient’s Address]
Reason for Referral:
The patient is being referred for [specific condition or reason for referral, e.g., gastrointestinal symptoms, suspected X disease]. The symptoms have been present for [duration of symptoms], and I believe a specialist evaluation is necessary.
Relevant Medical History:
The patient has a history of [list relevant medical conditions, surgeries, or treatments]. They are currently taking the following medications: [list medications].
Examinations and Investigations:
To date, the following examinations and investigations have been carried out: [list tests performed, e.g., blood tests, imaging studies, etc., along with results].
Further Action Required:
I request a thorough assessment and any further investigations that you deem necessary. Please consider scheduling an appointment at your earliest convenience.
Yours sincerely,
[Referring Doctor’s Signature]
[Referring Doctor’s Name]
[Referring Doctor’s Qualifications]
NHS Referral Letter Template UK (2)
From:
[Referring Doctor’s Name]
[Medical Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]
To:
[Receiving Doctor’s Name or Department]
[Hospital Name]
[Hospital Address]
[Hospital Phone]
Date:
[Date of Referral]
Subject:
Referral for [Patient’s Full Name], [Patient’s Date of Birth]
Dear [Receiving Doctor’s Name],
Patient Overview:
Name: [Patient’s Full Name]
Date of Birth: [Patient’s Date of Birth]
NHS Number: [Patient’s NHS Number]
Address: [Patient’s Address]
Reason for Referral:
This referral is for [explain the specific condition or pathology]. The patient has presented with the following symptoms: [list symptoms], which have persisted for [duration].
Medical Background:
The patient has previously been diagnosed with [list any medical issues]. They are under treatment for [list treatments and medications].
Previous Investigations:
The following tests have been performed: [list any relevant tests, their findings, and recommendations based on those results].
Request for Assistance:
I kindly request your assessment and any further management you deem appropriate. An appointment at your earliest convenience would be appreciated.
Yours faithfully,
[Referring Doctor’s Signature]
[Referring Doctor’s Name]
[Referring Doctor’s Qualifications]

Printable

PDF – 1 PDF – 2

Nhs Referral Letter Template UK