ENT Referral and Re-Referral (Sea to Sky)

OVERALL_INSTRUCTIONS

Chief Complaint

Consult Letter Template

Template

Dear [Referring Clinician] Thank you for referring [Patient Name] to see me. This [Patient Description, e.g., pleasant 55-year-old] is on [Treatment/Medication, e.g., SLIT]. [General Condition/Status, e.g., Her allergies are well-controlled.] [Additional Relevant Details, e.g., She is on Symbicort 2 puffs daily and feel much better.] [Other Medications/Usage, e.g., She uses Dymista occasionally.] [Symptom Scores/Assessments, e.g., Their SNOT-22 score is low, and OSA-13 is noted.] [Patient Feedback, e.g., Her feel better on SLIT.] On Examination: Left Ear: External Canal: [Findings — if not provided, default to "normal"] Tympanic Membrane: [Findings — if not provided, default to "normal"] Right Ear: External Canal: [Findings — if not provided, default to "normal"] Tympanic Membrane: [Findings — if not provided, default to "normal"] Nose: Turbinates: [Findings — if not provided, default to "normal"] Fiberoptic: [Findings — if not provided, default to "normal"] Oral Cavity: [Findings — if not provided, default to "normal"] Tonsils: [Grade and describe condition] Impression: 1. [Primary Impression, e.g., Allergies - well controlled] 2. [Secondary Impression, e.g., On SLIT regularly] Plan: [For each treatment plan, provide a concise description including the medication or therapy name, dosage or frequency, duration, and any specific instructions or patient preferences. Include follow-up plans with specific time frames.] 1. [Plan Item 1, e.g., Continue SLIT daily — patient prefers to continue despite completing 5 years as they feel allergies worsen when discontinued.] 2. [Plan Item 2, e.g., Dymista as needed.] 3. [Plan Item 3, e.g., Symbicort daily — instructions provided.] 4. [Follow-up Plan, e.g., Fup in 6/12] Thank you for involving me in the care of your patient. Dr. []