A tool to assess the quality of consultation and referral request letters
Consultation and Referral Request Letter Assessment Tool | ||||
Date of letter: ______________________________________ | ||||
Discipline letter directed to: ________________________ | ||||
A. Content | ||||
1. Patient demographics | YES | NO | ||
2. Initial statement identifying the reason for the referral | YES | NO | ||
3. Description of chief complaint | YES | NO | ||
4. Description of associated symptoms | YES | NO | ||
5. Description of relevant collateral history | YES | NO | ||
6. Past medical history | YES | NO | ||
7. Past surgical history | YES | NO | ||
8. Relevant psychosocial history | YES | NO | ||
9. Current medication list | YES | NO | ||
10. Allergies | YES | NO | ||
11. Relevant clinical findings | YES | NO | ||
12. Results of investigations to date | YES | NO | ||
13. Outline of management to date | YES | NO | ||
14. Provisional diagnosis or clinical impression | YES | NO | ||
15. Statement of what is expected from the referral | YES | NO | ||
B. Style | ||||
16. One topic per paragraph | YES | NO | ||
17. Paragraphs with fewer than 5 sentences | YES | NO | ||
18. One idea per sentence | YES | NO | ||
C. Overall appreciation | ||||
Letter unhelpful to consultant | Informative helpful letter | |||
1 | 2 | 3 | 4 | 5 |