October 15, 2023
Dr. Emily Johnson
Smile Bright Orthodontics
123 Braces Lane
Springfield, IL, 62701
(555) 123-4567
emily.johnson@smilebright.com
Dear Dr. Robert Smith,
Re: Referral for Dental Evaluation and Treatment
I am writing to refer my patient, John Doe, born on March 5, 2005, for a dental evaluation and any necessary treatment. Below, I have provided relevant clinical information to assist in your assessment and management.
- Reason for Referral: John has been experiencing persistent discomfort in his lower molars, which may require further evaluation for potential cavities or other dental issues.
- Medical History: John has a history of asthma, managed with inhalers, and no previous surgeries.
- Medications: Currently taking Albuterol inhaler as needed.
- Allergies: No known allergies.
- Social History: John is a non-smoker and is currently a high school student.
- Previous Dental History: John had braces removed last year and has had regular dental check-ups every six months.
I would appreciate it if you could provide a detailed report of your findings and any treatment plans you propose. Please do not hesitate to contact me if you require any further information.
Thank you for your attention to this matter.
Sincerely,
Dr. Emily Johnson
Orthodontist
Smile Bright Orthodontics
[Date]
[Referring Clinician's Name]
[Referring Clinician's Practice Name]
[Referring Clinician's Address]
[City, State, ZIP Code]
[Phone Number]
[Email Address]
Dear [Dentist's Name],
Re: Referral for Dental Evaluation and Treatment
I am writing to refer my patient, [Patient's Full Name], [Patient's Date of Birth], for a dental evaluation and any necessary treatment. Below, I have provided relevant clinical information to assist in your assessment and management.
- Reason for Referral: [describe the specific dental issues or concerns that prompted the referral] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- Medical History: [provide a brief summary of the patient's relevant medical history, including any chronic conditions or previous surgeries] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- Medications: [list current medications and herbal supplements the patient is taking] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- Allergies: [mention any known allergies] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- Social History: [describe relevant social history, such as smoking, alcohol use, or occupation] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
- Previous Dental History: [provide any relevant information about the patient's past dental treatments or issues] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
I would appreciate it if you could provide a detailed report of your findings and any treatment plans you propose. Please do not hesitate to contact me if you require any further information.
Thank you for your attention to this matter.
Sincerely,
[Referring Clinician's Name]
[Referring Clinician's Title]
[Referring Clinician's Practice Name]