What should be included in a medical referral letter?

A complete referral letter should include: patient demographics and insurance information, reason for referral with specific clinical question, relevant medical history and current medications, allergies, diagnostic workup completed with results, urgency level (routine/urgent/emergent), and your contact information for questions. Include enough detail for the specialist to understand the clinical context without redundant information.

How do I indicate the urgency of a referral?

Clearly state urgency at the top of the referral: Routine (can wait weeks), Urgent (should be seen within days to 1-2 weeks), or Emergent (same day/next day). For urgent cases, call the specialist's office directly in addition to sending the written referral. Document why the referral is urgent to help with scheduling prioritization.

Should I include the diagnosis or just symptoms in a referral?

Include your working diagnosis if you have one, but also describe the clinical presentation and diagnostic uncertainty if present. For example: 'Suspected inflammatory bowel disease based on chronic diarrhea and elevated inflammatory markers, requesting colonoscopy for definitive diagnosis.' This helps the specialist understand your clinical reasoning.

How do I handle referrals when prior authorization is required?

Check insurance requirements before sending the referral. If prior authorization is needed, submit it before or simultaneously with the referral. Include authorization number in the referral letter once obtained. Notify the patient that the appointment cannot be scheduled until authorization is approved. Document authorization attempts in the patient's chart.

What information should I request back from the specialist?

Request: consultation findings, recommended treatment plan, whether they will manage the condition or return care to you, any procedures performed with results, medication changes, and follow-up plan. Specify your preferred communication method (fax, patient portal, EHR message) and timeline for response.

Medical Referral Letter Template - Specialist Referral

Administrative — Medical Referral Letter Template

Administrative Primary Care Updated: 11/7/2025

The Medical Referral Letter Template is designed for primary care providers and specialists writing referral letters to other healthcare providers for consultation, specialized care, or procedures. This template provides a structured format for communicating patient information, clinical history, reason for referral, specific questions or goals for the consultation, and relevant clinical data. The template ensures complete information transfer between providers, facilitates timely specialist evaluation, supports care coordination, and improves patient outcomes through effective provider communication. Key sections include patient demographics and insurance information, referring provider information, reason for referral with clinical context, relevant medical history and current medications, diagnostic workup completed and results, specific questions or goals for the consultation, urgency of referral, and patient instructions. This template streamlines the referral process, reduces communication gaps between providers, and ensures specialists receive complete clinical information for efficient evaluation. Ideal for primary care practices making specialty referrals, specialists referring to other specialists, and practices managing complex patients requiring multiple provider coordination.

Letter Header

Referring provider name, credentials, practice name
Address, phone, fax, NPI
Date

Patient Information

Patient name, DOB, insurance ID, phone
Referring to: [Specialist name, specialty, practice]

Reason for Referral

Primary reason: [Specific condition or concern]
Clinical context: [Why referral is needed]
Urgency: Routine / Urgent / Emergent

Relevant Medical History

Current diagnoses: [List relevant conditions]
Current medications: [List with dosages]
Allergies: [List allergies]
Past medical history: [Relevant history]
Past surgical history: [If relevant]

Diagnostic Workup

Tests completed: [Labs, imaging, other tests]
Results: [Key findings]
Pending tests: [If applicable]

Specific Questions / Goals for Consultation

1) [Specific question or goal]
2) [Additional questions or goals]

Clinical Summary

[Brief summary of patient's condition and why specialist evaluation is needed]

Provider Contact Information

For questions or to discuss: [Contact information]

Provider Signature

[Signature, credentials, date]