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Referral / transfer of care note template

Designed for outbound referrals and care transitions: why you’re referring, what’s already done, what you need from the specialist, and what the patient was told—so the next clinician isn’t guessing.

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Template content

Copy or download, then paste into Wavo under My Templates.

Referral / Transfer of Care Note

Referring Clinician & Recipient
- Referring clinician/practice and receiving clinician/specialty/facility.
- Preferred contact method and urgency (routine, soon, urgent).

Reason for Referral / Transfer
- Specific clinical question or requested service (evaluate, procedure, co-manage, assume care).
- Patient goals related to the referral if discussed.

Clinical Summary
- Concise relevant history, key exam findings, and working diagnoses.
- Pertinent PMH, medications, allergies, and psychosocial barriers to care.

Workup to Date
- Labs, imaging, procedures, and prior specialty input already completed (with dates/results when known).
- Pending studies the receiving clinician should expect.

Treatments Tried
- Therapies, medications, and responses relevant to the referral reason.

Requested Actions
- What you are asking the receiving clinician to do (opinion, procedure, ongoing management, diagnostics).
- Any time-sensitive concerns or red flags.

Patient Communication
- What the patient was told; appointments pending; records sent or to be sent.
- Barriers (transport, cost, language) and supports arranged if discussed.

When to use this template

What makes the structure useful, and which visits it fits best.

Why this template works

Structural advantages for real documentation

Best for

Visit types and clinicians who use this format

  • States a clear clinical question or requested service up front.
  • Summarizes workup-to-date so receiving clinicians avoid duplicate testing.
  • Documents urgency, patient awareness, and pending results.
  • Works for specialty referral letters and transfer-of-care summaries.
  • 1Specialty referrals from primary care
  • 2Transfer of care between clinicians/clinics
  • 3Post-acute or cross-facility care handoffs

Example output shape

Illustrative excerpt of how a visit can land in this structure. Not a real patient record—review and edit every note before signing.

Recipient
GI for evaluation of iron-deficiency anemia and consideration of bidirectional endoscopy. Urgency: within 4 weeks.

Reason
Persistent IDA despite oral iron; FIT negative ×1; no overt GI bleeding. Request EGD/colonoscopy and recommendations on iron repletion route.

Clinical Summary
58-year-old with fatigue; Hb 9.8, ferritin 12, MCV 72. Denies melena/hematochezia; occasional NSAID use. On omeprazole PRN. NKDA. Family history: father colon cancer age 62.

Workup to Date
CBC, iron studies, B12/folate normal except iron deficiency; celiac serology negative; FIT negative. CT abdomen not done. Pending: repeat CBC next week—results will be forwarded.

Treatments Tried
Ferrous sulfate 325 mg daily ×8 weeks with partial Hb rise (8.9→9.8); constipation limited adherence.

Patient Communication
Patient agrees to GI referral; aware of bowel prep and hold-NSAID advice. Records and labs faxed today. Call our office with questions; patient has transportation via daughter.

How Wavo automates this

What the product actually does with your template.

1. Add the template

Paste this content into My Templates, or start from a specialty-generated template and edit the sections.

2. Record or dictate

Capture the encounter with ambient recording or dictation. Wavo structures the note using your template.

3. Review and sign

Edit with Smart Transform if needed, then export or copy into your EHR. You stay responsible for the final note.

Put this template to work on your next visit

Start free, paste the template, and see how Wavo documents in your structure.

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