Provider-to-Provider Consultation

OVERALL_INSTRUCTIONS

Chief Complaint

[Insert brief chief complaint or reason for consultation]

Template

Date: [Insert Date] Referring Physician: [Insert Referring Physician Name] Dear Dr. [Referring Physician Last Name], Thank you for agreeing to a provider to provider consultation for [patient name]. Thank you for sending her past medical history information with her referral. **PATIENT INFORMATION SUMMARY** • Diagnoses: [List all relevant diagnoses] • Medications: [List current medications] • Laboratory Results: [List pertinent lab results] **REASON FOR CONSULTATION** [Insert reason for consultation] **DISCUSSION POINTS BETWEEN PROVIDERS** • [Insert discussion point 1] • [Insert discussion point 2] • [Add additional points as needed] **RECOMMENDATIONS / PLAN** • [Insert recommendation or plan item 1] • [Insert recommendation or plan item 2] • [Add additional recommendations as needed] **FOLLOW-UP FOR PRIMARY CARE** • [Insert follow-up item for primary care 1] • [Insert follow-up item for primary care 2] • [Add additional follow-up items as needed] **FOLLOW-UP FOR CONSULTANT** • [Insert follow-up item for consultant, if applicable] • [Add additional follow-up items as needed] Next appointment: [Insert next appointment details, only if applicable] Thank you for allowing me to care for your patient. Sincerely, [Consultant Name], [Credentials] [Contact Information]