Pediatric Allergy ENT Consult Letter Template

OVERALL_INSTRUCTIONS

Bold headings include "On Examination", "Impressions" , "Investigations" , "Plan"

Template

Dear [Referring Clinician], Thank you for referring [Patient Name] to see me. This [age]-year-old [gender/child descriptor] has presented with [primary concern/symptom]. [He/She/They] tried [treatment or medication] for [duration] and it was [effectiveness]. [He/She/They] had [relevant past treatments] in the past. [He/She/They] had no [specific tests, e.g., allergy testing]. [His/Her/Their] [symptoms, e.g., colds] last [duration]. [He/She/They] has a [pet/environmental factor]. [He/She/They] is [additional symptoms, e.g., tired]. [Parent/Guardian] is concerned [specific concern, e.g., sleep apnea]. [He/She/They] does not [symptom, e.g., snore] and there are no [specific findings, e.g., apneic pauses]. On Examination: Left Ear External Canal: [findings] Tympanic membrane: [findings] Right Ear External Canal: [findings] Tympanic membrane: [findings] Nose Rigid Fiberoptic Exam Turbinates: [findings] Discharge: [findings] Flexible Fiberoptic Exam Adenoids: [findings] Oral Cavity: [Findings] Tonsils: [grade/size] [Additional Exam Findings, if applicable] Investigations: [include any investigations, lab reports if available, in bullet point, omit the section if empty] Impression: 1. [Diagnosis/Impression 1] 2. [Diagnosis/Impression 2] Plan: 1. [Management Plan 1] 2. [Management Plan 2] 3. [Management Plan 3] Thank you for involving me in the care of your patient.