Generation Health Clinic Referral Form

Generation Health Clinic Referral Form Date: 01 November 2024 Referring Clinician Details: Name: Dr. Sarah Jenkins Specialty: General Practitioner Practice Name: Cityside Medical Centre Contact Number: 020 7946 0011 Email: s.jenkins@citysidemedical.co.uk Patient Details: Full Name: Mr. David Miller Date of Birth: 15/03/1975 Gender: Male Contact Number: 07700 900345 Email: david.miller@example.com Address: 12 Elm Street, London, E1 6FG NHS Number: 123 456 7890 Reason for Referral: Mr. Miller, a 49-year-old male, is being referred for further evaluation and management of persistently elevated HbA1c levels and new onset fatigue, despite lifestyle modifications and initial metformin therapy. His most recent HbA1c was 8.2% (previously 7.5% three months ago). He reports increased thirst and occasional nocturia. There is a family history of Type 2 Diabetes Mellitus in his paternal lineage. Given the rapid progression and his symptoms, we are seeking specialist endocrinology input to optimise his diabetic management and rule out other endocrine causes. Relevant Medical History: * Hypertension (managed with Amlodipine 5mg OD) * Dyslipidaemia (managed with Atorvastatin 20mg OD) * Diagnosed with Type 2 Diabetes Mellitus 1 year ago. * No known allergies. Current Medications: * Metformin 1000mg BID * Amlodipine 5mg OD * Atorvastatin 20mg OD Relevant Investigations (Date and Result): * HbA1c: 8.2% (25/10/2024), 7.5% (25/07/2024) * Fasting Glucose: 9.8 mmol/L (25/10/2024) * Lipid Panel: Total Cholesterol 5.2 mmol/L, LDL 3.1 mmol/L, HDL 1.1 mmol/L, Triglycerides 1.8 mmol/L (25/10/2024) * Thyroid Function Tests: TSH 2.1 mIU/L, Free T4 16 pmol/L (within normal limits) (20/10/2024) * Urine Microalbumin/Creatinine Ratio: 15 mg/g (normal) (25/10/2024) Preferred Consultant (if known): Any available endocrinologist specialising in diabetes management. Urgency: Routine Additional Notes/Instructions for Generation Health Clinic: Please advise Mr. Miller on any specific preparations for his appointment. We would appreciate a detailed management plan upon your assessment. Patient is aware of the referral and is keen to attend. He is available for appointments on weekday afternoons.