Clinical template

Medical Referral Letter Template with Examples

A referral letter tells a specialist who the patient is, why they are coming, what you have already done, and what you want the specialist to do. Use the blank below, then three fictional Canadian letters: orthopedics, psychiatry, and cardiology.

Blank referral letter template

Copy this onto letterhead or into Ocean, eReferral, or a Scribeberry letter template. One page is enough if every field earns its place. Attach relevant labs and imaging rather than pasting a 12-page chart dump.

Specialist referral letter

[Clinic letterhead]
Date:
To: Dr. [Name], [service / clinic], [hospital or office]
Fax / eReferral ID:

Re: [patient full name], DOB [YYYY-MM-DD], [sex], [PHN / OHIP / PHC / PHN-A]
Address / phone / preferred language / interpreter needed:
Family physician / NP (if not you):

Reason for referral (one sentence):
Urgency: routine / soon / urgent  —  clinical reason for that urgency:
What I am asking you to do: consult / take over / procedure / second opinion / transfer of care

History of present problem:
Pertinent past medical / surgical history:
Medications (dose) / allergies:
Social: work, smoking, alcohol, caregiving, driving if relevant

Exam findings relevant to this referral:
Investigations done (dates and results) and still pending:
Treatments already tried and response:

Red flags considered:
Patient goals / constraints (travel, work, needle phobia, language):

Sincerely,
[Name, designation, college number, direct phone]

Fictional patients

Every example on this page uses made-up names and findings. They are teaching material. They are not a substitute for provincial eReferral rules, billing, or your own clinical judgment. Review every generated letter before it is sent.

What the specialist actually needs

Central intake nurses and consultants triage from the letter. A missing laterality, a missing medication list, or 'please see for knee pain' with no duration sends the referral back or parks it in a low-urgency pile. Write the ask in one sentence at the top. 'I am requesting arthroscopic opinion for suspected bucket-handle meniscal tear, right knee, locking, MRI attached' is triable. 'Knee pain, thanks' is not.

Element	Why it is there	Common miss
Demographics and PHN	Booking, billing, and matching imaging	No phone number the clerk can actually reach
The ask	Consult vs procedure vs transfer of care	Referring 'for an MRI' when you can order it yourself
History and treatments tried	Avoids repeating failed drugs and shows medical necessity	No physio, no NSAID trial, no duration
Meds and allergies	Drug interactions and procedure planning	'See EMR' on a fax the consultant cannot open
Investigations with dates	Stops duplicate CT and shows urgency	Pasting raw lab dumps with no interpretation
Urgency reason	Central intake uses this, not the word URGENT in caps	Marking everything urgent

Canadian pathways differ by province: Ocean eReferral, Alberta Netcare advice, RAPID access cardiology, youth mental-health intake. If a named pathway exists, use it and still send a letter that stands alone. CMPA advice on referrals is consistent: the referring clinician remains responsible until the consultant has accepted, and the chart should show what was sent, when, and any delayed-appointment safety-net you gave the patient.

How to write the letter

Lead with demographics, then the reason and the ask. History is the problem at hand, not the entire CPP. Include comorbidities that change risk (anticoagulation before a procedure, lithium before a psych admission, CKD before contrast). Exam is the findings that justify the referral, not a normal systems sweep.

List treatments tried with enough detail that the specialist does not restart the same SSRI or the same six weeks of unused physio. Attach PDFs of MRI reports and key labs. If you want the specialist to take over care, say so. If you want a one-visit opinion and you will keep prescribing, say that too. Patients should know whether they are waiting for advice or for a surgeon.

Example 1 — orthopedics

Family medicine to orthopedic surgery

54-year-old man, Ottawa. Mechanical locking of the right knee. Fictional.

Glebe Family Health
Ottawa ON  |  613-555-0160
Date: 18 March 2026
To: Dr. N. Kowalski, Orthopedic Surgery, TOH Civic — eReferral #44119

Re: Tomasz Wójcik, DOB 1971-09-03, male, OHIP 1234-567-890
Phone 613-555-0188. English. Family physician: myself.

Reason: Right knee locking and recurrent effusion after a twist on ice in January; suspected meniscal tear. Asking for surgical opinion (arthroscopy vs conservative).
Urgency: soon — true locking 3 times in 2 weeks, cannot squat or descend stairs at work (warehouse).

History: 54M, no prior knee surgery. 12 January 2026 slipped on ice, felt a pop, swelling within hours. Ongoing medial joint-line pain. True locking (stuck in 20° flexion) x 3, unlocked with shaking. No giving-way of the other knee. No fever. BMI 29. Type 2 diabetes, metformin only.

Exam (18 Mar): Antalgic gait. Right knee effusion 1+. Medial joint-line tenderness. McMurray painful with click. ROM 5–110°. Stable ACL/PCL/collaterals. Neurovascular intact.

Investigations: X-ray 20 Jan — no fracture, mild medial OA. MRI 2 Mar — complex tear posterior horn medial meniscus, small effusion, chondral thinning medial tibial plateau (report attached). A1c 7.1% (Jan).

Tried: Physio x 6 weeks (quad sets, ROM), ibuprofen 400 mg PRN (GI upset), activity modification. Still locking.

Ask: Consult for arthroscopic partial meniscectomy vs repair vs non-operative care. Happy to keep primary care. Patient prefers to avoid time off if a brace will do; wants a clear recommendation.

Sincerely,
Dr. M. Singh, CCFP  CPSO # 234567  Direct 613-555-0161

Example 2 — psychiatry

Family medicine to adult psychiatry

29-year-old woman, Victoria. Treatment-resistant depression. Fictional.

James Bay Medical
Victoria BC  |  250-555-0133
Date: 5 May 2026
To: Adult Psychiatry intake, Island Health  —  fax 250-555-0134

Re: Elena Cho, DOB 1996-12-14, female, PHN 9876 543 210
Phone 250-555-0119. Prefers English. Interpreter not required. Lives with partner. Works remotely in tech.

Reason: Recurrent major depression, two adequate antidepressant trials plus CBT, still PHQ-9 18, passive SI without plan. Asking for psychiatric consult regarding next-step medication (augmentation vs switch) and whether specialized psychotherapy is indicated.
Urgency: soon — functional decline at work, SI present but no plan/intent, safety-net in place. Not an involuntary certification case.

History: First episode 2019 after a bereavement; responded to sertraline. Current episode since Nov 2025: anhedonia, 4 kg loss, early waking, impaired concentration. No mania, no psychosis, no PTSD criteria met. Alcohol 2–4 drinks on weekends, no daily use, no substances. No prior admission.

Meds: Escitalopram 20 mg daily x 12 weeks (partial; sexual side effects). Previously venlafaxine XR 225 mg x 10 weeks (sweats, no benefit). Bupropion not tried. Lorazepam 0.5 mg PRN, uses ~4x/month. NKDA.
Tried: CBT 8 sessions (private, 2026), still attending. Exercise when energy allows.

Exam / MSE (5 May): Groomed, restricted affect, linear thought, passive SI "I wish I wouldn't wake up," no plan, no intent, no firearms. Partner aware. Cognition grossly intact. Insight good.

Labs: TSH 1.8, CBC/ferritin/B12 normal (April).

Ask: Consult only; I will continue prescribing in the interval. Please advise on augmentation vs switch and on whether a mood-disorder program waitlist is appropriate. Patient has extended health for some psychology.

Sincerely,
Dr. R. Gill, CCFP  CPSID 77881  Direct 250-555-0135

Example 3 — cardiology

Family medicine to cardiology

61-year-old woman, Winnipeg. Palpitations and near-syncope. Fictional.

Corydon Medical Clinic
Winnipeg MB  |  204-555-0170
Date: 22 June 2026
To: Dr. P. Rahman, Cardiology, St. Boniface — rapid-access / arrhythmia clinic

Re: Margaret Fontaine, DOB 1964-11-02, female, PHIN 456 789 123
Phone 204-555-0171. English. Lives alone. Still driving.

Reason: Recurrent palpitations with two near-syncopal episodes; ECG today shows new atrial fibrillation with rate 118. Asking for cardiology assessment regarding rate vs rhythm strategy, anticoagulation, and whether admission is needed.
Urgency: urgent — new AF plus near-syncope. She is in clinic, hemodynamically stable, being sent to ED if you cannot see her today; copy of this letter to ED.

History: 61F. Palpitations x 3 weeks, worse last 4 days. Two near-faints at the sink, no complete LOC, no chest pain, no focal neuro symptoms. No fever. Sleeps poorly. 8 cups coffee/day. EtOH 1–2 wine most evenings. No known heart disease. Hypertension on amlodipine 5 mg. No prior stroke. CHADS-VASc: hypertension + age + sex = 3.

Exam: Alert. BP 138/86 both arms, HR 114 irregular, RR 16, SpO2 97% RA. No failure (no crackles, no edema, JVP not elevated). No murmur. Neuro exam normal.

Investigations: ECG 22 Jun 11:10 — AF, rate 118, no STE, QTc 430 (attached). Troponin in lab, pending. TSH pending. Last lipids (2025) LDL 2.4. Cr 68, eGFR 82.

Meds: Amlodipine 5 mg daily. NKDA. Not on anticoagulation.

Ask: Please assess today or advise ED. I have not started a beta-blocker yet because of near-syncope and no prior echo. I have explained stroke risk and that she should not drive until you or ED clear her (I have documented this). Happy to start DOAC if you confirm no contraindication.

Sincerely,
Dr. H. Berger, CCFP  CPSM 33445  Direct 204-555-0172

Mistakes that show up in referrals

No ask: the consultant cannot tell if you want an operation, a diagnosis, or a takeover of prescribing.
No meds, no allergies, no phone number.
Marking routine degenerative joint disease as 'urgent' so the truly locked knee waits longer.
Referring for a test you can order (MRI, Holter, BHCG) without a clinical question.
Sending an unsigned AI letter with '[specialist name]' still in brackets.
No record in the chart of what was sent, when, and what you told the patient to do if they worsen while waiting.

CMPA has repeatedly advised that a referral is not a completed transfer of responsibility until it is accepted. If the wait is long, the chart needs a safety-net (when to go to ED, who to call) and, for high-risk problems, a documented attempt to find a faster pathway. Colleges expect the letter to be accurate. Generated text does not change who signed.

eReferral, fax, and the copy in the chart

Ocean, Alberta referral pathways, and hospital fax still fail in ordinary ways: wrong laterality, expired imaging, a PDF the consultant cannot open. Keep a copy of the sent letter in the EMR. If the patient is waiting for cardiology with new AF, the wait advice belongs in the same day's SOAP, not only in the letter.

Draft the referral from the visit

Scribeberry listens to the encounter, or takes dictation, and drafts a referral in your template with meds, the ask, and the urgency line. Edit, then Smart Push or export to Ocean / fax. Pro is $99/month after the free trial.

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Frequently asked questions

What must a medical referral letter include?

Patient identifiers and a reachable phone number, a one-sentence reason, what you want the specialist to do, relevant history, meds and allergies, exam, investigations with dates, treatments already tried, and why the urgency is what it is. Attach key reports.

How long should a referral letter be?

One page is enough for most family-medicine referrals. Multi-page pasting of the entire chart hides the ask. Add a second page only for a complex medication list or a timeline the consultant truly needs.

Who is responsible while the patient waits?

You are, until the consultant accepts the referral. Document what you sent, when, and the safety-net. CMPA's referral advice is consistent on this point across provinces.

Can Scribeberry write referral letters?

Yes. Use a referral template, generate from the visit, then check the ask, meds, and attachments before sending. Custom templates can match Ocean fields or your hospital's intake form.

Templates