Free Transfer of Care Letter Design Template
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]
