Here are some key points
to include in your refferal:
Patient demographics
Include the patient's full name, date of birth, contact information, and any relevant identification numbers or medical record numbers.
Referring healthcare professional information
Provide your name, contact information, and clinic details as the referring healthcare professional. This helps the specialist to communicate with you and provide updates on the patient's progress.
Reason for referral
Clearly state the reason for the referral, indicating the upper limb condition or symptoms that the patient is experiencing. Describe the specific concerns or issues that require specialized assessment or treatment.
Relevant medical history
Include the patient's relevant medical history, such as any previous upper limb injuries, surgeries, or treatments. Mention any chronic conditions or comorbidities that may impact the upper limb condition.
Diagnosis or provisional diagnosis
If a diagnosis has been made or there is a provisional diagnosis based on your evaluation, provide this information. It helps the specialist to understand the context and tailor their assessment and treatment accordingly.
Treatment provided and outcomes
Briefly describe the treatment you have provided as a hand therapist or physiotherapist, including the techniques, modalities, and exercises used. Summarize the patient's response to the treatment and any progress or challenges encountered.
Functional limitations
Describe any functional limitations the patient is experiencing due to the upper limb condition. This could include difficulties with activities of daily living, work-related limitations, or impact on quality of life.
Goals and expectations
Share the patient's goals and expectations regarding their upper limb condition. This helps the specialist align their treatment plan with the patient's desired outcomes.
Diagnostic tests and imaging
If the patient has undergone any diagnostic tests or imaging related to the upper limb condition, provide the results or attach the reports. This gives the specialist additional information for their evaluation.
Medications and allergies
Include a list of current medications the patient is taking, including any over-the-counter medications or supplements. Also, mention any known drug allergies or adverse reactions the patient may have.
Any additional relevant information
Include any other relevant information that may assist the specialist in providing appropriate care. This could include psychosocial factors, occupational demands, or any specific concerns or questions the patient may have.