Referral Letter Template Medical – Australia

The Referral Letter Template – Medical – Australia is offered in multiple formats, including PDF, Word, and Google Docs. These formats are both modifiable and printable, crafted to accommodate your requirements with convenience.

Template – (Open)

Complete Template Online

Sample

Referral Letter Template Medical – Australia

Editable | Printable

(PDF – 1) (PDF – 2)

Complete Template Online

1. Referring Physician Information




2. Patient Information



3. Referral Date

4. Reason for Referral

5. Relevant Medical History

6. Necessary Tests/Procedures

7. Urgency of Referral

8. Additional Notes

9. Signatures


PDF

WORD

Examples

Referral Letter Template – Medical – Australia (1)
From:
[Referring Doctor’s Name]
[Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]
To:
[Receiving Doctor’s Name]
[Specialty/Practice Name]
[Receiving Practice Address]
[Receiving Practice Phone]
[Receiving Practice Email]
Date:
[Date]
Subject:
Referral for [Patient’s Name], [Patient’s ID]
Dear [Receiving Doctor’s Name],
Patient Details:
Name: [Patient’s Name]
Date of Birth: [Patient’s DOB]
Gender: [Patient’s Gender]
Contact Information: [Patient’s Contact Info]
Medical History:
[Brief Summary of Patient’s Medical History]
Reason for Referral:
[Detailed Explanation of Symptoms/Conditions Leading to Referral]
Requested Services:
I kindly request your assessment and management regarding [specific assessments/tests/treatments desired].
Attachments:
[List any attached medical records, test results, or imaging studies]
Thank you for your assistance.
Sincerely,
[Referring Doctor’s Signature]
[Referring Doctor’s Name]
[Qualifications]
Referral Letter Template – Medical – Australia (2)
From:
[Referring Doctor’s Name]
[Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]
To:
[Receiving Doctor’s Name]
[Specialty/Practice Name]
[Receiving Practice Address]
[Receiving Practice Phone]
[Receiving Practice Email]
Date:
[Date]
Subject:
Referral for [Patient’s Name], [Patient’s ID]
Dear [Receiving Doctor’s Name],
Patient Background:
Name: [Patient’s Name]
Date of Birth: [Patient’s DOB]
Gender: [Patient’s Gender]
Contact Information: [Patient’s Contact Info]
Clinical Summary:
[Detailed Summary of the Patient’s Current Condition, Treatments to Date, and Response]
Purpose of Referral:
The purpose of this referral is to seek your expert opinion regarding [specific issues].
Required Actions:
Please assess and provide recommendations for [desired assessments/treatments].
Documentation Included:
[List any relevant attachments including test results or imaging that accompany the referral]
I appreciate your attention to this matter and look forward to your feedback.
Best regards,
[Referring Doctor’s Signature]
[Referring Doctor’s Name]
[Qualifications]

Printable

PDF – 1 PDF – 2

Referral Letter Template Medical - Australia