Medical referral letter template

A referral letter is read by someone deciding how soon to see your patient and what to prepare. The clearer your question, the better the answer. This page has a blank referral letter, an invented example for a changing skin lesion, the faults that slow triage, and how ClearPass writes a referral letter from the visit note.

What the receiving clinician needs

Triage is often done in a minute or two per letter. The person reading wants to know: why this patient, why now, what exactly you want from them, what you have already tried, and how urgent it is. Everything else supports those points.

State the question explicitly. Please assess and manage is acceptable, but please advise whether this lesion needs excision, or please assess for surgical options after failed physiotherapy, gets a more useful answer. Include medicines and allergies, and relevant results with dates. Mention anything that affects the visit itself, such as interpreter needs or mobility.

Blank referral letter

To: [receiving service or clinician]
From: [referring clinician, clinic, contact]
Date: [ ]
Patient: [identifiers as your service requires]
Urgency: [routine / soon / urgent] - reason:

Reason for referral:
Specific question:

History of the problem:
Relevant examination findings:
Investigations (with dates):
What has been tried and the response:
Relevant background:
Current medicines:
Allergies:
Practical needs: [interpreter / mobility / other]
Patient is aware of and agrees to this referral: yes

[Signature, name, role]

Filled example: referral to dermatology

To: Dermatology outpatient service
Urgency: soon - changing pigmented lesion

Reason for referral: pigmented lesion on the right calf that has changed over 3 months.
Specific question: please assess and advise whether excision is needed.

History: 46-year-old noticed a mole on the right calf becoming darker and larger since the spring. Occasional itch, no bleeding. Fair skin, several sunburns in childhood. No personal history of skin cancer; sister had a melanoma removed in her 40s.
Examination: 8 x 6 mm lesion, asymmetric, two shades of brown with an irregular border. No other atypical lesions seen on the back or limbs. No palpable lymph nodes in the right groin or popliteal fossa. Clinical photographs taken with consent.
Investigations: none.
Tried: nothing; not suitable for observation given change.
Background: hypothyroidism. Medicines: levothyroxine 75 micrograms daily. Allergies: none known.
Practical needs: none.
Patient is aware of and agrees to this referral.

What slows a referral down

• No specific question, so the receiving clinic cannot tell what outcome you want.
• Urgency marked without a reason, which makes triage harder to trust.
• Missing medicines or allergies, forcing a phone call before the visit.
• Results mentioned without values or dates.
• Letters written as a copy of the whole consultation note, hiding the key points in a page of routine detail.

How ClearPass writes a referral letter

Once the visit note is ready, choose Referral letter and it is written from that note in one click. The letter is addressed to the receiving specialty and states the reason for referral, the relevant history and findings, what has been tried, and the specific question for the receiving clinician. There is an optional box for extra detail, for example to dermatology, soon, and it adds nothing clinical that the note does not say.

That last point matters: if the examination findings were never said or typed during the visit, they will not be in the letter either. You can edit the letter in place before copying it, and you should read it as carefully as you would a letter a colleague drafted for you. Transcribed visits in other languages still produce the letter in English. If the referral is for insurance approval rather than a clinical opinion, the prior authorization letter page covers that separate workflow.

What ClearPass does not do

• It does not replace your judgement. Every note is an AI draft that you review and correct before it is used.
• It is not a medical device and does not make clinical decisions. It is a documentation aid.
• It does not connect to your EMR. The note is copy-ready text that pastes into any system.

Privacy

Clinical note content is not stored on ClearPass servers: it is processed to write the note, then discarded. Consultation audio is transcribed and discarded, never stored. Your note history stays in your browser, on your device, and you choose how long it is kept. Common identifiers are removed from typed and transcribed text before it reaches the AI; that is a best-effort safeguard, so leave names, ID numbers and file numbers out where you can. Processing goes through the AI providers named in our Privacy Policy, which sets out exactly what each one receives and how long it keeps it. ClearPass does not sign HIPAA business associate agreements today.

Questions

Related

• Consultation note template for specialists
• Medical report template
• Patient instructions template
• An AI medical scribe for general practitioners
• Prior authorization letters written from the visit itself