General Practitioner Template
Radiology referral
A professional General Practitioner template for healthcare professionals.
About this template
Need a clear and concise way to request imaging for your patients? This Radiology Referral template is perfect for General Practitioners. It helps you document the patient's history, symptoms, and clinical findings, ensuring all necessary information is included for the radiologist. This template streamlines the referral process, making it easier to request the appropriate imaging studies. It's designed to capture the essential details needed for an effective referral, saving you time and improving communication with radiology departments. This template is ideal for GPs looking to improve their referral documentation.
Preview template
Patient: Mrs. Eleanor Vance, [insert age] 68 years old.
History: Presents with a 2-week history of worsening right hip pain, exacerbated by weight-bearing and activity. No history of trauma. Previous episodes of similar pain, but this is the most severe.
Symptoms: Right hip pain, described as aching and throbbing. Pain radiates to the groin and occasionally down the anterior thigh. Reports stiffness in the morning.
Clinical Findings: Limited range of motion in the right hip, particularly internal rotation and flexion. Tenderness to palpation over the greater trochanter. No neurological deficits.
Clinical Question: Rule out osteoarthritis or other bony abnormalities of the right hip. Please provide an X-ray of the right hip.
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Specialty
General Practitioner
Used
8 times
Type
Note
Last edited
2026-04-13
Created by
William Gordon-Wright