Orthodontist Template

Referral Letter to Dentist

A professional Orthodontist template for healthcare professionals.

About this template

This Referral Letter to Dentist template is designed for clinicians who need to refer patients for further dental evaluation and treatment. It includes sections for patient information, medical and dental history, and specific reasons for referral, ensuring comprehensive communication between healthcare providers. This template is ideal for creating detailed and organized referral letters to dentists, facilitating seamless collaboration in patient care. Use this template with Heidi, the AI medical scribe, to efficiently generate professional referral letters tailored to each patient's needs.

Preview template

October 15, 2023 Dr. Emily Johnson Smile Bright Orthodontics 123 Braces Lane Springfield, IL, 62701 (555) 123-4567 emily.johnson@smilebright.com Dear Dr. Robert Smith, Re: Referral for Dental Evaluation and Treatment I am writing to refer my patient, John Doe, born on March 5, 2005, for a dental evaluation and any necessary treatment. Below, I have provided relevant clinical information to assist in your assessment and management. - Reason for Referral: John has been experiencing persistent discomfort in his lower molars, which may require further evaluation for potential cavities or other dental issues. - Medical History: John has a history of asthma, managed with inhalers, and no previous surgeries. - Medications: Currently taking Albuterol inhaler as needed. - Allergies: No known allergies. - Social History: John is a non-smoker and is currently a high school student. - Previous Dental History: John had braces removed last year and has had regular dental check-ups every six months. I would appreciate it if you could provide a detailed report of your findings and any treatment plans you propose. Please do not hesitate to contact me if you require any further information. Thank you for your attention to this matter. Sincerely, Dr. Emily Johnson Orthodontist Smile Bright Orthodontics

[Date] [Referring Clinician's Name] [Referring Clinician's Practice Name] [Referring Clinician's Address] [City, State, ZIP Code] [Phone Number] [Email Address] Dear [Dentist's Name], Re: Referral for Dental Evaluation and Treatment I am writing to refer my patient, [Patient's Full Name], [Patient's Date of Birth], for a dental evaluation and any necessary treatment. Below, I have provided relevant clinical information to assist in your assessment and management. - Reason for Referral: [describe the specific dental issues or concerns that prompted the referral] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.) - Medical History: [provide a brief summary of the patient's relevant medical history, including any chronic conditions or previous surgeries] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.) - Medications: [list current medications and herbal supplements the patient is taking] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.) - Allergies: [mention any known allergies] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.) - Social History: [describe relevant social history, such as smoking, alcohol use, or occupation] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.) - Previous Dental History: [provide any relevant information about the patient's past dental treatments or issues] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.) I would appreciate it if you could provide a detailed report of your findings and any treatment plans you propose. Please do not hesitate to contact me if you require any further information. Thank you for your attention to this matter. Sincerely, [Referring Clinician's Name] [Referring Clinician's Title] [Referring Clinician's Practice Name]

Browse more templates

Use this template