New Peds Patient Consult (Burnaby)

OVERALL_INSTRUCTIONS

Concise

Chief Complaint

Consult Letter Template

Template

Dear [Referring Clinician]: Thank you for referring [Patient Name] to see me. This [Patient Description, e.g., pleasant X-year-old] has presented with [Consult Purpose, e.g., ear infection]. [Patient Name] reported [Relevant History, e.g., waking up in the middle of the night with ear pain X months ago]. This occurs [Frequency, e.g., once a year]. [Patient Name] has been treated with [Treatment Details, e.g., antibiotics], and the condition resolved. [Additional History, e.g., one hearing test showed mild loss in the left ear, not repeated]. [Speech Development Status, e.g., no speech delay]. [Swimming History, e.g., not swimming at the time]. [Allergy Status, e.g., no allergies]. [Family History, e.g., no family history of ear disease]. [Medication History, e.g., previously used avamys]. [Other Relevant Details, e.g., was told there is wax in the ear, occasionally used oil]. On Examination: Left Ear: External Canal: [Findings, e.g., cerumen, removed] Tympanic membrane: [Findings, e.g., normal, mild negative pressure] Right Ear: External Canal: [Findings, e.g., normal] Tympanic membrane: [Findings, e.g., normal] Nose: Turbinates: [Findings, e.g., specify or leave blank if not examined] Fiberoptic: [Findings — if not provided, default to "normal"] Oral Cavity: [Findings, e.g., normal] Tonsils [grade, i.e. removed, 1/4] Impression: 1. [Diagnosis/Impression 1, e.g., AOM x 1 year - likely to outgrow this soon, consider tubes if 4x/year] 2. [Diagnosis/Impression 2, e.g., CS spray for 3 weeks with URI or 2/12 if hearing decreases] 3. [Diagnosis/Impression 3, e.g., cerumen left ear removed] Plan: 1. [Plan Item 1, e.g., audiogram and follow-up if abnormal] 2. [Plan Item 2, e.g., oil in ears weekly, no q-tips] Thank you for involving me in the care of your patient. Dr. Maureen M Harriman, MD, FRCSC