Referral letter template

Thank you for seeing Mr. Robert. He is a patient with a history of type 2 diabetes mellitus and hypertension.

Reason for Referral: Mr. Robert is referred for personalized dietary guidance to better manage his type 2 diabetes mellitus and hypertension. His recent laboratory results show a fasting glucose of 7.8 mmol/L, HbA1c of 7.2%, LDL cholesterol of 2.4 mmol/L, and triglycerides of 1.8 mmol/L. He is currently making efforts to improve his diet and increase physical activity, including walking regularly. Specific dietary recommendations include focusing on high-fibre, low-glycemic foods, avoiding sugary drinks, and reducing sodium intake to about 1 teaspoon per day, including processed and restaurant foods.

Medical History
- Type 2 diabetes mellitus without complications (E11.9)
- Essential (primary) hypertension (I10)
- Other hyperlipidemia (E78.49)

Surgical History
- None

Allergies
- No known drug allergies

Active Medications
- Metformin, taken daily
- Ramipril, taken daily

Thank you for seeing this patient and sharing in their care. Your assistance for our patient and myself is much appreciated.

We kindly ask that your MOA FAX us a notice of appointment for our records with the details of your office phone number, office location, date and time of your appointment to xxxxxxxxxx.

Sincerely,

Dr. Daniel Lee