Referral/Consult Summary Letter (Hematology to Referring Clinician)

Letter Date: [Date]

Encounter Date: [Date]

Setting: [outpatient / inpatient / telehealth]

To: [Referring clinician name, credentials, clinic/facility]

CC: [Additional recipients as appropriate]

Re: [Patient name], DOB [xx/xx/xxxx] – [Referral question or suspected diagnosis]

Patient: [Name]

DOB: [xx/xx/xxxx]

Salutation and Summary

Dear [Referring clinician name, credentials]:

[Brief acknowledgment and restatement of the referral question] (One to two sentences.)

• Impression: [Working or final hematology diagnosis] ([confidence: low / moderate / high])
• Key data: [Most salient supporting results with dates] (List only 2–4 items that drive the conclusion.)
• Top recommendations: [[Heme] / [PCP] / [Other]] [Action item with timing] (Use explicit ownership tags.)
• Follow-up: [Who follows what, when, and scheduling responsibility]
• Urgent communication: [Date, participants, and key decisions] (Only include if direct communication occurred.)

Clinical Context and Key Data

[Patient age, key comorbidities, presenting issue with timeline, and pertinent history relevant to the hematology question] (1–3 sentences. Focus on details that change hematology management.)

• [Key objective data: test, result with value/units, date, final or preliminary status, brief interpretation]
• [Additional pivotal result or pathology with date and management impact]
• [Trend summary if clinically meaningful]
• [Critical information unavailable and potential impact] (Include only if applicable.)

Hematology Impression

(Present problems in order of clinical priority. Tie each diagnosis to supporting evidence.)

[Problem 1]: [Diagnosis or working diagnosis] ([new / chronic / improving / worsening])

Confidence: [low / moderate / high]

Rationale: [Concise rationale citing key data with dates]

Differential: [Alternatives that will change next steps, with discriminating plan] (Include only if action-linked.)

[Problem 2]: [Diagnosis or working diagnosis] ([status])

Confidence: [low / moderate / high]

Rationale: [Key supporting data and reasoning]

Differential: [If applicable]

Recommendations and Follow-up

• [[Heme]] [Diagnostic action with purpose and timing]
• [[Heme] / [PCP] / [Other]] [Treatment recommendation with dose, route, duration, and monitoring parameters]
• [[PCP] / [Other]] [Co-management tasks as relevant to hematology]
• [[Heme]] [What the patient was told about diagnosis and plan]
• [[Heme] / [PCP]] [Safety-net instructions: red flags and where to seek care]

Pending Results

• [Test name], [date obtained], [expected turnaround], [responsible party: Heme / PCP / Other]

(Omit this section if no studies are pending.)

Follow-up Plan

• Hematology follow-up: [Needed / Not needed]; [timeframe]; [who schedules]
• Referring clinician responsibilities: [Monitoring tasks with intervals and escalation thresholds]
• Escalation triggers: [Specific clinical or lab triggers and urgent contact method]
• Availability: Please contact me if the clinical course changes or questions arise.

Sincerely,

[Hematologist name, credentials]
[Role and supervising physician if applicable]
[Clinic/service name]
[Contact: phone, fax, secure message]
[After-hours contact pathway]

(Keep this letter concise and scannable. Include only data directly relevant to the hematology question. Omit sections without available information. Aim for approximately one page.)