Letter to Referring Provider (Nutrition Consultation Summary)

Nutrition Consultation Summary – Letter to Referring Provider

(Replace all bracketed placeholders with concise clinical content. Omit sections with no relevant content. Target ≤1 page for routine ambulatory cases. Include "not available" statements only when safety-critical. Attribute data sources as per chart, patient-reported, or observed.)

Date of Letter: [Date of letter]

Date of Encounter: [Encounter date]

To: [Recipient name, credentials, clinic/service]

From: [RDN name, credentials, organization, callback number]

Patient: [Full name, DOB, MRN]

Encounter Type: [in-person / telehealth] [with interpreter / with caregiver] (Include interpreter/caregiver only if applicable.)

Re: [Reason for referral]

Dear [Recipient name / Team],

[One-sentence consultation framing: patient name/age, referral reason, encounter date, and bottom-line nutrition issue] (If referral question was unclear, state what was addressed and invite clarification.)

• [Primary nutrition diagnosis in plain English]
• [Key nutrition-related risk or safety issue]
• [Plan highlights most relevant to the referral]
• [Top requested medical action(s)]

(Include the above At-a-Glance bullets only if the case is complex; otherwise omit.)

Assessment & Nutrition Diagnosis

[Brief selective findings that support the nutrition diagnoses: pertinent anthropometrics/weight trend, relevant labs with dates, key intake patterns and adequacy vs. needs, notable barriers or context, medications/supplements affecting nutrition status] (Attribute each data point to source. Include only what directly supports diagnoses and requested follow-up.)

Nutrition Diagnoses

(List 1–3 diagnoses in priority order using problems addressable by nutrition intervention.)

[Diagnosis 1 label]: [Problem] related to [Etiology] as evidenced by [Signs/Symptoms].

[Diagnosis 2 label]: [Problem] related to [Etiology] as evidenced by [Signs/Symptoms]. (Include only if applicable.)

[Diagnosis 3 label]: [Problem] related to [Etiology] as evidenced by [Signs/Symptoms]. (Include only if applicable.)

Care Plan & Goals

Nutrition prescription: [Established targets: calories, protein, carbohydrate distribution, fluids, texture modifications, oral nutrition supplements as applicable]

Education & counseling: [Key topics covered and individualized strategies provided]

Patient-centered SMART goals:

• [Goal 1: specific behavior, measurable target, frequency, start date]
• [Goal 2: specific behavior, measurable target, frequency, start date]
• [Additional goals as applicable, 2–5 total]

Safety notes: [Hypoglycemia education, food–drug interactions, allergy precautions, refeeding or aspiration risk] (Include only if relevant.)

RDN follow-up: [Planned follow-up interval, modality, and parameters to monitor]

Requested Medical Follow-up

(Prioritize 1–4 actionable items. Phrase as recommendations.)

1. Please consider [specific action: lab order, medication review, referral, supply order, or clearance]. — [One-line rationale]. [Suggested timeframe and responsible party].
2. Please consider [specific action]. — [One-line rationale]. [Suggested timeframe and responsible party]. (Include only if applicable.)
3. Please consider [specific action]. — [One-line rationale]. [Suggested timeframe and responsible party]. (Include only if applicable.)

Closing

Thank you for the referral and collaboration. I am available to discuss these recommendations at [callback number or secure email]. Next planned nutrition follow-up: [date/timeframe and modality].

Sincerely,

[RDN name, credentials, license]
[Department/Organization]
[Direct phone] | [Secure email] | [Fax]

Attachments: [List of attachments: handouts, meal plan, logs] (Include only if attachments were provided.)