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Dentist Template

Generic Referral - EMIS

A professional Dentist template for healthcare professionals.
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Specialty

Dentist

Used

59 times

Type

Document

Last edited

10/14/2025

Created by

Anonymous

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About this template

This Generic Referral - EMIS template is designed for dentists to efficiently refer patients to specialists, such as oral surgeons, for further evaluation and management. It includes sections for detailing the patient's clinical concerns, history, examination findings, and any investigations performed. This template is ideal for dental professionals seeking to streamline the referral process, ensuring all pertinent information is communicated clearly to the specialist. Using Heidi, this template can be automatically populated with relevant patient data, enhancing accuracy and saving time for busy dental practices.

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Referral to Oral Surgery Department. Dear Dr. Sarah Johnson, I am referring Mr. John Smith for further evaluation and management under your care as a routine referral. The primary reason for this referral is the assessment and management of a persistent lesion on the lower left gum, which has been present for approximately three months. The patient has a history of recurrent oral ulcers and discomfort in the affected area. They also have a significant past medical history of type 2 diabetes, which is well-controlled with medication. Additionally, the patient is a non-smoker and consumes alcohol occasionally. On examination, there is a 1 cm ulcerated lesion on the lower left gum, with mild surrounding erythema and tenderness upon palpation. Investigations performed to date include a panoramic dental X-ray taken on 10/15/2023, which showed no significant bony abnormalities. The working diagnosis is a possible oral lichen planus, but further evaluation is needed to rule out other conditions. In terms of management, the patient has been advised to maintain good oral hygiene and has been prescribed a topical corticosteroid to manage inflammation. I would greatly appreciate your specialist input to confirm the diagnosis and recommend further management, including any necessary biopsy or additional imaging. Thank you for your attention to this referral. Please do not hesitate to contact me if you require any further information. Yours sincerely, Dr. Emily Brown Dentist Greenwood Dental Clinic, 123 Main Street, Anytown, AT 12345, Phone: (555) 123-4567

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