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General Practitioner Template

Radiology referral

A professional General Practitioner template for healthcare professionals.
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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.
[very brief summary of the patient's medical history, current symptoms, clinical findings relevant to the referral, and the specific reason for requesting an x-ray examination. Complete prose/full sentences are not required. Put the clinical question last] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely.) (Never come up with your own patient details, assessment, plan, interventions, evaluation, and 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, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely.) (Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)
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Use this template

Specialty

General Practitioner

Used

8 times

Type

Note

Last edited

13/04/2026

Created by

William Gordon-Wright

Document

Lettre d’Adressage

Ilan Douenias

General Practitioner, France

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