Medical referral letter template, with a worked example

A medical referral letter asks another clinician or service to see your patient. It states the reason and urgency, summarises the relevant history, lists findings and current treatment, and ends with the questions you want answered. Below is a one-page medical referral letter template, a worked example, and how Scripta drafts the letter from the visit.

Transcription and the draft note are usually ready within 1–3 minutes of pressing Stop; the note itself takes about 20–40 seconds.

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Scripta drafts documentation of what was said in the visit; the clinician reviews, edits and signs; it does not diagnose.

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What should a referral letter include?

Five parts: the reason for referral and its urgency, a clinical summary, the relevant findings, the current treatment, and the specific questions you want answered. Allergies and anything already tried belong in it every time.

Reason for Referral
What you are asking the recipient to do, and how urgent it is, as you stated it.
Clinical Summary
The relevant history of the presenting problem, and the background history.
Relevant Findings
Examination findings and results stated during the visit.
Current Treatment
Current medicines with doses, and the treatments tried so far.
Specific Request
The questions you want answered, and any practical details mentioned, such as contact or timing.

Referral letter example: GP to gastroenterology

The rice farmer's epigastric pain returned a week after four weeks of omeprazole, so the doctor referred him to the gastroenterology team at the provincial hospital for an endoscopy and H. pylori testing. This is the letter Scripta drafted from that visit and the earlier notes linked by his HN.

Referral letterReferral after the pain returned · not urgentFictional patient for illustration

Reason for Referral

Referral to the gastroenterology team at the provincial hospital for upper GI endoscopy (EGD) and H. pylori testing. Burning epigastric pain returned one week after completing a 4-week course of omeprazole; please check for an ulcer.

Urgency: not urgent; endoscopy within one month.

Clinical Summary

  • First presented with burning epigastric pain after taking mixed pills and ibuprofen. Treated with omeprazole for 4 weeks, with improvement while on treatment.
  • Pain returned one week after stopping: burning, worse on an empty stomach, waking the patient at night.
  • No vomiting, no black stools, no weight loss.
  • Has not resumed the mixed pills or other painkillers; takes paracetamol only for back pain. Has stopped drinking alcohol.
  • Background: hypertension.
  • Allergy: amoxicillin (itchy rash), as reported by a pharmacy via the patient's daughter.

Relevant Findings

  • BP 130/82 mmHg, pulse 80
  • Epigastric tenderness

Current Treatment

  • Omeprazole 20 mg once daily before breakfast (restarted while awaiting endoscopy)
  • Amlodipine 5 mg once daily
  • Paracetamol as needed for back pain
  • Mixed pills and ibuprofen: stopped
  • Advised to go to hospital immediately if vomiting blood, passing black stools or pain gets much worse

Specific Request

  • Upper GI endoscopy (EGD) to check for an ulcer
  • H. pylori testing
  • Allergic to amoxicillin: please avoid it if antibiotics are needed
  • Currently taking omeprazole; the patient has been told to stop it before the endoscopy if your team advises this

Please verify (shown to the clinician, not part of the note)

  • The amoxicillin allergy was reported by a pharmacy via the patient's daughter and is not yet confirmed from records; please verify before sending.
  • Paracetamol dose and frequency were not stated at this visit.

How do you state urgency and the question you need answered?

Put both near the top. Say what you want done, how soon and why, then end the letter with the questions you want answered, one per line. A specialist should know within two sentences why the patient is coming.

  • Urgency with a reason: "Not urgent; endoscopy within one month."
  • Questions a specialist can answer: "Is there an ulcer? What is the H. pylori status?" rather than "please see and advise".
  • Practical points: an allergy to avoid, a medicine to stop before a procedure, how to reach you.

Can the letter be drafted in English from a Thai consultation?

Yes. The note language is chosen separately from the language spoken in the visit, so a consultation held in Thai can produce a referral letter in English, for a private or international hospital or a patient going abroad.

Referral letters take their headings from the note language (Reason for Referral in English, a Thai heading in Thai), unlike SOAP, H&P and progress notes, which always keep English headings.

Can I paste it into a referral system or hospital form?

Yes. The letter is plain text: copy the whole draft or one section into your hospital's referral form or referral system. Scripta does not replace official forms or scheme rules; it drafts the clinical content that goes into them.

What should I say during the visit so the referral drafts itself?

Tell the patient, in plain words, who you are referring them to, why and how soon. That sentence gives the draft its reason and urgency; the rest comes from the history, examination and plan you discuss.

  • Name the service and what you want: "I'll refer you to the stomach specialists at the provincial hospital for a camera test."
  • Say the urgency, and why.
  • Mention allergies and what has been tried, with doses.
  • Say the questions you want answered.
  • Link the visit to the patient's HN so the summary can draw on earlier notes.
  • Choose English as the note language if the letter is going to an English-speaking team.

How does Scripta draft a referral from the visit and earlier notes?

It drafts the five sections from today's conversation and, when the visit is linked by HN, from the most recent earlier note for the story so far. It records urgency only as you stated it, and flags anything it could not confirm, such as an allergy reported second-hand.

  • Today's findings come only from today's conversation; the earlier note supplies history, not today's examination.
  • Unconfirmed details are flagged, like the amoxicillin allergy in the example, reported by a pharmacy through the patient's daughter.
  • You add letterhead, name and signature, and review it before sending.
  • Patients can speak Thai, Thai mixed with English, or Isan, Northern or Southern Thai: Scripta accepts the speech, writes the note in standard Thai (or English, if you choose), and flags any word it isn't sure of for you to check.

Copy the referral letter template

A one-page referral with the five sections, a greeting and a sign-off. Fill it in yourself, or let Scripta draft the five sections from the visit.

Plain text, ready to paste into your HIS or EMR
Dear Dr ____ / ____ team,

Reason for Referral
What I am asking you to do:
Urgency, and why:

Clinical Summary
The presenting problem and its timeline:
Relevant background history:
Allergies (with the reaction):

Relevant Findings
Examination:
Results (with dates):

Current Treatment
Current medicines (dose, frequency):
Treatments already tried, and the response:

Specific Request
The questions I would like answered:
Practical details (what the patient has been told, timing, how to reach me):

Yours sincerely,
[Name, position, clinic, phone]

Frequently asked questions

How long should a referral letter be?

One page is usually enough. Put the reason and urgency first, keep the history to what the specialist needs to decide, list current medicines and allergies, and end with the questions you want answered. A longer letter tends to bury the one line the receiving team reads first.

What should never be left out of a referral letter?

Allergies, current medicines and what has already been tried. A specialist who does not know about an amoxicillin allergy, or that four weeks of omeprazole helped only while it was being taken, may repeat or risk something you have already ruled out.

Can Scripta draft the letter from earlier visits too?

Yes. When the visit is linked to the patient's HN, the draft reads the most recent earlier note for continuity, so the clinical summary can cover the first presentation and the treatment so far, while today's findings come from today's conversation.

Who signs the referral letter?

You do. Scripta drafts the five sections of the letter from the visit; you review them against what was said, resolve anything under Please verify, add your letterhead, name, position and contact details, and sign before the letter is sent. The referring clinician stays responsible for its content.

Does it replace my hospital's referral form?

No. Official referral forms and the rules of each healthcare scheme stay as they are. Scripta drafts the clinical content of the letter as plain text, which you can copy whole or section by section into your hospital's form or referral system, then complete the administrative fields there.

What does "refer" mean in medicine?

To refer is to send a patient to another clinician or service for an opinion, a test or a treatment you cannot provide yourself, such as an endoscopy at a provincial hospital. The referral letter is the clinical handover that goes with them, so the receiving team knows why they are coming.

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