Ms Jane Rudik (receiver's name)

Community Nurse (their job titles)

Newtown Community Health Centre (address)
12 Hampton Street
Newtown

Dear Ms Rudik, / Dear Sir/Madam,

 
Re: Ms Mary Bell (patient's name)

 Form of an introduction

I am writing to refer
Mr/Mrs 000 , a(n) 00 year-
to request daily home visits old-patient
to

to request a medical
assessment of

to our hospital
following a fall
(accident)
due to an episode of
seIzure (symptoms)
who was admitted with a diagnosis on the 3rd of
of type 2 diabetes October .(the day of
  (diagnosis) the admission)

to undergo total hip
replacement
(operation name)

After a full recovery she/he is due to back to your today

from the be discharged care
injury/disease,
home on (date of the
the surgery, discharge)

Ex)
I am writing to refer Mrs.000, a 45 year-old-patient who was admitted due to a
concussion following a fall at home on the 1st of July. After a full recovery from the
injury, she is due to be discharged home tomorrow.

Current situation

writing about the patient's current situation.

Why they are admitted to hospital
What is the progress after hospitalisation
What is the plan in the future
 
1. Describing the patient on the day of the admission 

On admission, she/he complained of constant

pain in her/his neck (patin location).
she/he appeared to be disoriented (her
condition visually) possibly caused by the
accident (cause)

2. After admission and an initial medical examination, revealed diagnosis or suspected

condition

Based on initial examinations, it was revealed that her right arm was

broken ( indisputable diagnosis)

it was considered that he might have

COPD (suspected condition)

3. Explaining medications or therapy treated to the patient while hospitalising

During her/his stay in the She/He has received physiotherapy for

hospital, (disease/sympto
m).
She/He has been treated with antibiotic
therapy (Amoxicillin)

paracetamol 250mg bid (medication) was

 prescribed

4. the progress they have made during admission 

without any complications.

In addition, her/his wound is healing with no signs

For the past few days, she/he has
of infection.
recovered well

Furthermore, her/his hemoglobin level is now

within normal limits

5. Essential to be given to the patient after discharge

However, including daily dressings(treatment).

Neverthele
she/he still requires ongoing to improve her range of motion(purpose).
ss,
medical care

Nonethele until she/he has her/his staples

ss, removed(duration).

6. Plans & Follow-up

Her staples are scheduled to be removed at the follow-up appointment on date

Blood and urine tests will be conducted

The doctor will assess her progress in mobilising

※ Medical history

In terms of her/his medical history,

1. Introducing their chronic disease 

She/He has been diagnosed with diabetes (diagnosis) for which, she/he

since her
has been taking Metformin (medication)
childhood

She/he has experienced bouts of depression(name of a disease)

for the past
5 years
She/he has suffered from asthma

2. listing histories of diseases

 developed bowel cancer
in 2002
She/He
5 years ago
sustained forearm fracture following a car accident

3. listing what they are taking regularly

takes
She/he hypoglycaemic medications for type 2 diabetes
is on

4. explain the existence of the allergy

is allergic
Please note that she/he to penicillin/peanuts
has an allergy
※ Social background

1. Social determinants of health

patient's current situation whether there is someone to help them or if they are living
with others or not

Although she/he has a few relatives

living nearby,

she/he lives alone and is lacking adequate

As she/he has never got married, social support.

After her/his husband/wife died,

2. Need for social service or support 

Therefore
she/he would benefit from your help in monitoring her medication adherence.
,

Thus, please encourage her/him to participate in social activities.

it might be helpful to introduce her/him to some ways of doing moderate

Hence,
exercise.
※ Conclusion

1. Request for the performance.

if you could visit her/him and figure out what she/he needs (request to
consider patient's circumstances)
I would
appreciate it
if you could arrange someone who can offer her/him proper assistance 
/it would be
appreciated
if you could offer her/him what she/he requires (to the nurse in charge)

2. Closing comments

if you have any queries, please do not hesitate to contact me

Yours sincerely,

Registered Nurse