Results Summary Letter (Referring Provider)

Date: [Date of letter]

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

From: [Author name, credentials, service, direct contact number]

Patient: [Patient name, DOB, MRN] (If any identifier is unavailable, state "not provided in referral materials.")

Encounter Date(s): [Date(s) of testing/evaluation]

Purpose & Referral Question

[Brief opening acknowledging the referral and the testing/evaluation being summarized; explicitly restate the referral question as provided, or if not specified, describe the clinical indication addressed.] (Limit to 1–2 sentences.)

Clinical Context

(Include 3–5 bullets of high-yield information that materially affects interpretation. Omit full histories, medication lists, and exam findings. Note any critical missing context that limits interpretation.)

• [Key diagnoses, recent events, current symptoms, or risk factors relevant to interpretation]
• [Additional pertinent context]
• [Additional pertinent context]

Key Results

(Group by clinical theme rather than by individual test. Lead with abnormal findings that change management, followed by high-value negatives. Do not reproduce detailed tables or subtest scores.)

• [Clinical theme]: [Key finding(s) with relevance to referral question]
• [Clinical theme]: [Key finding(s), including pivotal negatives if applicable]
• Limitations: [Technical issues, incomplete testing, or confounders] (Include only if applicable.)
• Pending results: [What is pending, expected timeframe, and responsible party for communication] (Include only if applicable.)

Impressions

(Numbered, prioritized, and skimmable. Use certainty qualifiers such as "most consistent with," "suggestive of," or "cannot exclude." Directly answer each referral question. Include differential diagnoses only if they change next steps.)

1. [Primary impression/diagnosis with certainty qualifier] — [One-line rationale]
2. [Direct answer to referral question] — [Brief justification tied to results]
3. [Additional impression or differential, if applicable]

Recommendations & Follow-up

(Actionable items ordered by urgency. Specify action, rationale, responsible party, and timing for each. Avoid vague terms unless paired with explicit criteria.)

1. Action: [Specific action] — Rationale: [Tied to results] — Responsible: [Referrer / Consultant / Patient / Other] — Timing: [Timeframe or trigger]
2. Action: [Specific action] — Rationale: [Tied to results] — Responsible: [Referrer / Consultant / Patient / Other] — Timing: [Timeframe or trigger]

Follow-up with our service: [Planned follow-up or state that none is needed; include how referrer can reach author for discussion.]

Urgent communication: [Finding] communicated to [Name/Role] by [method] on [date/time]. (Omit this line entirely if no urgent communication occurred.)

Full report: [Attached / Available in EHR location] (Omit if no separate comprehensive report exists.)

[Author name, credentials, service]
[Contact information]
[Electronic signature]