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Dental Practitioner
5-10 minutes

Standard Referral - EMIS

The Generic Referral - EMIS template by s10.ai is crafted to empower dentists in seamlessly referring patients to specialists, including oral surgeons, for comprehensive evaluation and management. This template encompasses sections for documenting the patient's clinical issues, medical history, examination results, and any conducted investigations. It is perfect for dental professionals aiming to optimize the referral process, ensuring that all critical information is conveyed effectively to the specialist. By utilizing s10.ai, this template can be automatically filled with pertinent patient data, boosting accuracy and conserving time for bustling dental practices.

1,021 uses
4/5.0
D
Dr. Emily Carter
Template Structure

Organized sections for comprehensive clinical documentation

Referral to [specialty being referred to] (select the appropriate specialty for the referral).
Dear [Specialist's name/department],
I am referring [patient’s full name] for further evaluation and management under your care as [an urgent/a routine/a 2-week wait (choose one)] referral (select the appropriate urgency level based on clinical need).
The primary reason for this referral is [state the main clinical concern or key question for the specialist] (provide a concise summary of the patient's main problem and what is sought from the specialist).The patient has a history of [summarise presenting complaints] (include the main symptoms and their duration). They also have a significant past medical history of [detail significant past medical history related to the referral] (mention any past conditions relevant to the referral). Additionally, [include pertinent lifestyle or social history] (only if applicable, such as smoking, alcohol use, or occupational hazards).
On examination, [describe relevant examination findings] (summarise the examination findings that are significant for the referral, highlighting those that support the diagnosis or demonstrate the severity of the condition).
Investigations performed to date include [list relevant investigations such as imaging, blood tests, and other diagnostics] (provide details of the tests, the date they were carried out, and a brief summary of their results).
The working diagnosis or confirmed diagnosis is [state the diagnosis or working diagnosis if applicable] (only include if the diagnosis is established or if a probable diagnosis is suspected based on current findings).
In terms of management, [describe any treatments, medications, or interventions initiated so far] (list current treatments, doses, and any changes recently made in the patient’s management).
I would greatly appreciate your specialist input to [explain what further management or guidance is being sought] (clarify any specific concerns or requests for diagnostic, treatment, or management advice).
Thank you for your attention to this referral. Please do not hesitate to contact me if you require any further information.
Yours sincerely,
[Clinician's full name]
[Clinician's professional title]
s10.ai
(Never come up with your own patient details, assessment, plan, interventions, evaluation, or plan for continuing care – use only the transcript, contextual notes, or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, leave the relevant placeholder or section blank.)
Sample Clinical Note

Example of completed documentation using this template

Referral to Oral Surgery Department.
Dear Dr. Sarah Johnson,
I am referring Mr. John Smith for further evaluation and management under your care as a routine referral.
The primary reason for this referral is the assessment and management of a persistent lesion on the lower left gum, which has been present for approximately three months. The patient has a history of recurrent oral ulcers and discomfort in the affected area. They also have a significant past medical history of type 2 diabetes, which is well-controlled with medication. Additionally, the patient is a non-smoker and consumes alcohol occasionally.
On examination, there is a 1 cm ulcerated lesion on the lower left gum, with mild surrounding erythema and tenderness upon palpation.
Investigations performed to date include a panoramic dental X-ray taken on 10/15/2023, which showed no significant bony abnormalities.
The working diagnosis is a possible oral lichen planus, but further evaluation is needed to rule out other conditions.
In terms of management, the patient has been advised to maintain good oral hygiene and has been prescribed a topical corticosteroid to manage inflammation.
I would greatly appreciate your specialist input to confirm the diagnosis and recommend further management, including any necessary biopsy or additional imaging.
Thank you for your attention to this referral. Please do not hesitate to contact me if you require any further information.
Yours sincerely,
Dr. Emily Brown  
Dentist  
s10.ai, 123 Main Street, Anytown, AT 12345, Phone: (555) 123-4567
Clinical Benefits

Key advantages of using this template in clinical practice

  • The "Referral to [specialty being referred to]" template is an essential tool for healthcare professionals seeking to streamline the referral process to specialists. This comprehensive template ensures that all critical patient information is communicated effectively, enhancing the continuity of care and optimizing patient outcomes. By utilizing this template, clinicians can efficiently convey the urgency of the referral, the primary clinical concerns, and relevant patient history, including examination findings and previous investigations. This structured approach not only facilitates a seamless transition of care but also supports specialists in delivering targeted and timely interventions. Adopt this template to enhance your referral process, improve interdisciplinary collaboration, and ensure your patients receive the specialized care they need promptly.
Frequently Asked Questions

Common questions about this template and its usage

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Standard Referral - EMIS