Referral letter - asthma

Notes
Model letter sample 1

Model letter sample 2

Dr Jan Walker
Pulmonologist
Epstein Clinic
393 Victorian Road
Richmond, Melbourne

2 September 2017

Dear Dr Walker

Re: Susan Forrest (DOB: 19/05/1997) - (Re: patient and age / DOB. If age and DOB are both given, write
DOB instead)

Paragraph one: Patient / Condition / Purpose – formats are more or less fixed for all referral letters

I am referring Susan Forrest (*Patient), who has been suffering from asthma (*Condition), to you for
assessment and treatment evaluation (*Purpose)

Paragraph 2

Details:

Smoker – 7 years, 10-15/day

Father also has asthma
Asthma since age 4
Two previous asthma related hospital admissions, most recent 2015
Allergic rhinitis, eczema
Smoking cessation options discussed

Susan Forrest has a family history of asthma and has been suffering from asthma since 4 years old. In
addition, she experienced two asthma exacerbations (most recent in 2015) which caused her to become
hospitalized. She also presents with allergic rhinitis and eczema. On top of that, she has been smoking
around 10-15 cigarettes every day for the past 7 years.

Paragraph 3

Details: Current drugs: Ventolin (albuterol), symbicort (budesonide/formoterol) – twice daily, Zyrtec
(cetirizine). Non-compliance with preventive inhaler – “forgets”

Currently, she is administered with Ventolin (albuterol), symbicort (budesonide/formoterol) and Zyrtec
(cetirizine). She also mentions that she tends to forget to bring her preventive inhaler with her.
*Actually, we don’t have to include that much details on drugs. Simply: Currently, she is administered with
Ventolin (albuterol), symbicort and Zyrtec……

Paragraph 4

Details:

25/8/17, short of breath – ongoing, nocturnal cough 7 nights, Ventolin use increase
2/9/17 – pulse, temperature, BP within normal limits; CXR clear; FBE clear; PEF 400 L/min

She presented (came to) at my clinic on 25/8/17 complaining about an ongoing shortness of breath,
persistent night coughs, and the need to increase Ventolin usage. During her next visit on 2/9/17 (*This is
too long winded, use “one week later” instead since 25/8/17 to 2/9/17 is around one week). Her pulse,
temperature and blood pressure are all within normal limits, her chest X-ray is clear and her PEF is 400
L/min.

Paragraph 5

Details: assess and evaluate, ? continue with current meds

*Notice that the assessment and evaluation here are pretty brief. It didn’t specify assessment of what?
Evaluation of what? Here we can add more details based on our understanding of the case notes.

In the view of above, kindly conduct a thorough (comprehensive) assessment on Susan Forrest’s
respiratory condition and a detailed evaluation on the suitability of her current medications (detailed
evaluation if it is advisable for her to continue with her current medications). Should you have any
questions, please do not hesitate to contact me.