Transfer of Care Letter Design

Transfer of Care Letter Design

[Your Company Name]
[Your Company Address]
[Your Company Number]
[Your Company Email]

Date: [Month] [Day], [Year]

To:

Dr. [Recipient's Name]
[Recipient’s Title]
[Recipient’s Facility Name]
[Facility Address]
[City, State, ZIP Code]
Phone: [Recipient’s Phone Number]
Email: [Recipient’s Email Address]


From:

Dr. [Sender's Name]
[Sender’s Title]
[Sender’s Facility Name]
[Facility Address]
[City, State, ZIP Code]
Phone: [Sender’s Phone Number]
Email: [Sender’s Email Address]


Subject: Transfer of Care for [Patient’s Full Name], DOB [MM/DD/YYYY]


Dear Dr. [Recipient's Last Name],

I am writing to inform you of the transfer of care for our mutual patient, [Patient’s Full Name], who has been under our care for the past [duration]. Effective [Transfer Date], care responsibilities will be transferred to your facility for continued management.

Patient Information:

  • Full Name: [Patient’s Full Name]

  • Date of Birth: [MM/DD/YYYY]

  • Medical Record Number: [Patient’s Record Number]

  • Contact Information: [Patient’s Contact Information]

Reason for Transfer: [Provide a brief explanation of why the patient is being transferred.]

Medical History:

  • Primary Diagnosis: [Primary Diagnosis]

  • Secondary Diagnosis: [Secondary Diagnosis]

  • Past Treatments:

    • [Medication/Treatment 1]

    • [Medication/Treatment 2]

Current Condition: [Describe the patient's current health status and any ongoing issues.]

Treatment Plan:

  • Current Medications:

    • [Medication 1] [Dosage and Frequency]

    • [Medication 2] [Dosage and Frequency]

  • Upcoming Tests/Procedures:

    • [Test/Procedure Name] scheduled for [Date]

    • [Test/Procedure Name] scheduled for [Date]

  • Follow-Up Instructions: [Instructions or recommendations for ongoing care.]

Test Results:

  • Recent Lab Work: [Summary of recent test results]

  • Recent Imaging: [Summary of recent imaging results]

Care Instructions: [Provide any special instructions for the receiving provider.]

Patient Preferences: [Include any known preferences or concerns expressed by the patient.]

Consent and Authorization: The patient, [Patient’s Full Name], has provided written consent for the transfer of their medical information to your facility.

Attachments:

  • [Document 1]

  • [Document 2]

  • [Document 3]

Thank you for your attention to this matter. Please feel free to contact me if you require any additional information or have any questions.

Sincerely,

[Your Name]
[Sender’s Title]
[Your Company Name]
[Your Company Address]
[Your Company Number]
[Your Company Email]

Transfer Letter Templates @ Template.net