PCP Referral Letter Template (BC Guideline)

Patient Info: Mr. Samuel, [Age not provided], Male, 2026-02-06.

Reason for Referral:
    - Referral for personalized dietary guidance to support management of type 2 diabetes mellitus, hypertension, and hyperlipidemia.
    - The patient is seeking assistance with dietary modifications to improve blood sugar control, blood pressure, and lipid profile.

(Include What I’m Asking You To Do in bullets)
    - Provide tailored dietary recommendations focusing on a high-fiber, low-glycemic index diet.
    - Educate the patient on reducing sodium intake to approximately 1 teaspoon per day.
    - Assist the patient in understanding food labels and selecting low-sodium options.

One-Sentence Triage Summary:
    "Chronic management of type 2 diabetes mellitus, hypertension, and hyperlipidemia with a focus on dietary optimization."

Pertinent History:
    - The patient has a history of type 2 diabetes mellitus and hypertension. He is making efforts to improve his diet and increase physical activity.
    - Family history includes a younger brother recently diagnosed with diabetes.
    - Denies any side effects from current medications.

Treatments Tried:
    - Current medications include metformin and ramipril, both taken daily without side effects.

Exam Highlights:
    - Blood pressure: 138/84 mmHg.
    - Weight: 84 kg. BMI: 28.3.
    - Physical examination revealed no abnormalities, including intact foot sensation and no ulcers or skin issues.

Key Tests Done:
    - Fasting glucose: 7.8 mmol/L.
    - HbA1c: 7.2%.
    - LDL cholesterol: 2.4 mmol/L.
    - Triglycerides: 1.8 mmol/L.

Current Meds & Allergies:
    - Medications: Metformin and ramipril.
    - No known drug allergies.

Risk & Context:
    - The patient is motivated to improve his health and adheres to his current medication regimen. He monitors his blood glucose at home approximately three times per week.

Shared Plan Until Seen:
    - The patient will continue his current medications and home blood glucose monitoring.
    - He will maintain a log of blood glucose readings to bring to his next visit.
    - Laboratory tests will be repeated in 3 months.

Thank you for seeing the patient.

Sincerely,
Dr. Jordan Lee