Referring Clinician Update Letter (Orthotics/Prosthetics)

Date: [date of letter]

From: [O&P clinic name, clinician name and credentials, phone, fax or secure message endpoint]

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

Re: [Patient full name] (DOB: [MM/DD/YYYY]) — O&P Update: [device type/body region] — DOS: [service date(s)]

(Distinguish clinician-observed findings from patient-reported information. Do not infer diagnoses or coverage determinations without documented support. Omit sections that do not apply; for safety-critical items not assessed, explicitly state "not assessed today.")

Summary

[Purpose statement identifying referral context and visit type: [evaluation / fitting / delivery / follow-up]] (Limit to 1–2 sentences.)

• Primary reason for visit: [brief reason]
• Pertinent diagnosis/impairment: [diagnosis/impairment driving O&P need]
• Current functional status & mobility: [level of function, assistive devices used, living/terrain demands if relevant]
• Device status: [evaluated only / recommended pending authorization / fitted / delivered / adjusted today]
• Device type & key features: [device category, laterality, essential components/features]
• Patient response/tolerance: [comfort, skin response, functional performance] (If not assessed, state "not assessed today.")
• Follow-up plan: [timeframe and purpose]
• Immediate requests of referring clinician: [requested actions, or "none at this time"]

Clinical Findings

(Include when findings inform device selection or safety; omit for routine adjustment visits with unchanged findings. Label patient-reported vs clinician-observed.)

Background relevant to device selection: [concise background directly informing O&P decisions—amputation details for prosthetics, pertinent neurologic/orthopedic conditions for orthotics, prior device history, activity/environmental demands as relevant]

• Skin/tissue status: [findings] (If not assessed, state "not assessed today.")
• ROM/Strength: [relevant measures/findings]
• Gait & balance observations: [key deviations, assistive device use, balance]
• Standardized measures: [test name and results] (Include only if performed this visit.)
• Patient-reported symptoms/goals: [patient-reported information]

Device

Device recommended/provided: [device type and laterality] — [key components/features including joints, materials, suspension, accommodations as applicable]

[Clinical rationale linking device features to functional needs and examination findings]

Status: [recommendation pending order / pending authorization / fabrication in progress / fitted today / delivered today / adjusted today]

Alternatives considered: [alternatives and rationale] (Include only if discussed.)

If fitted/delivered today:

• Fit & alignment: [overall fit, alignment, interface/pressure areas]
• Functional check: [activities performed and safety/performance observations]
• Modifications: [adjustments made]
• Safety considerations/restrictions: [temporary restrictions or precautions]

Education & training: [donning/doffing, wear schedule, skin checks, care/maintenance; note whether patient demonstrated competency or requires caregiver assistance] (Include only if education provided.)

Plan & Requested Actions

Follow-up: [specific timeframe and purpose]

Earlier evaluation triggers: [e.g., persistent redness >20–30 minutes after doffing, pain, device malfunction, falls]

Therapy referral: [discipline and goals] (Include only if indicated.)

Requested actions from referring clinician: [specific requests with rationale and time sensitivity—e.g., updated prescription wording, supporting documentation, medical evaluation for identified issues, clarification of weight-bearing status or functional goals] (If none, state "none at this time.")

Please contact our office directly with any questions or to discuss this plan.

[Clinician signature]

[Clinician printed name], [credentials]
[Clinic name] | [Phone] | [Fax or secure messaging]

cc: [Other providers] (Include only if copies sent.)

(This letter is a clinical communication tool and does not replace required orders, prior authorization packets, or proof-of-delivery documentation.)