New Patient Consultation

OVERALL_INSTRUCTIONS

Chief Complaint

Consult Letter Template

Template

DATE OF SERVICE: [Insert today's date] PATIENT: [Patient's name] Dear Dr. [Referring Clinician]: I had the pleasure of seeing this [Age]-year-old today. Thank you for referring [patient_first_name], a [age]-year-old [sex], for ophthalmologic evaluation. Reason for Visit: [reason_for_consultation] Ocular History: - Previous ocular surgeries: [surgery_details] - [ocular_history] - Current ocular medications: [medication_name], [dose], [frequency], [route] Relevant Medical History: - [medical_condition] Systemic Medications: [list these medications at top, if currently taking or has taken in the past = Tamsulosin, Flomax, Plaquenil, Hydroxychloroquine] [do not include frequency, route, or dosage] Examination Findings: - Visual Acuity (best-corrected): OD [value], OS [value] - Glare Testing [include when availabe]: OD [value], OS [value] - Intraocular Pressure (mmHg): OD [value], OS [value] - Central Corneal Thickness (microns) [include when available]: OD [value], OS [value] Investigations Reviewed [include when available]: - Macular OCT: OD [finding], OS [finding] - Optic Nerve OCT: OD [finding], OS [finding] - Optos ultra-widefield imaging: OD [finding], OS [finding] - Visual field: OD [finding], OS [finding] Impression: - [diagnosis] Recommendations: - [recommendation] - Reassessment recommended: [timeframe] Should you have any concerns or questions, please do not hesitate to contact me.