Referral Letter template
Professional letter referring a client to another provider or specialist.
- 21 fields across 7 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
From
- Practice nameText
- Practice addressText
- Practice phoneText
- Practice emailText
- Letter dateDate
To
- Recipient name and credentialsText
- Recipient practice / agencyText
- Recipient addressText
- Dear colleague,
Referral
- Client nameText
- Client date of birthDate
- Service requestedText
- I am writing to refer the client named above for the service requested above. Thank you in advance for your assessment.
Reason for Referral
- Reason for ReferralText
Relevant History
- Presenting concernsText
- Working diagnosis (with code)Text
- Current medications (and prescriber)Text
- Risk factorsText
Services to Date
- Services to dateText
Attachments
- Other attachmentsText
- Your name and credentialsText
- License numberText
- Referring clinician signatureSignature
- Signed HIPAA authorization
- Most recent progress note
- Please contact me using the details above if you need any additional information. I appreciate your time and care.
- Sincerely,
When to use it
Use a letter when you refer a client on or write to another professional about their care, with the client’s agreement.
How it works in MyWellOps
- Start the letter from the template on the client’s record.
- Fill in the details for this client and this referral.
- Keep a copy on the record with everything else.
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