OPTIONAL - Insert Business Logo, Business Address, Business Contact Number
Reference –<insert thisusually first four letters of surname, and first name initial, DOB year and reference point, e.g. R1 (report 1) or R2 (report 2), usually the same as the file name. Purpose: if the GP / Nurse calls you, and wants to discuss a letter for a patient, this may assist both parties in identifying the letter to be discussed.
Insert GP Details
Insert Date
Dear Dr. <insert last name>,
RE:insert patient title, full patient name, DOB, Medicare Number>
Thank you for your referral of insert patient title, patient surname> for exercise physiology services.
insert patient title, patient surname> attended the clinic on <insert clinic attendance date>. I have attached a summary of my assessment on the following page.
<Insert any concerns, or a brief summary of your consultation. We recommend no more than two paragraphs
E.G.1 During the assessment Ms. New Patient described her previous attempts to attain a healthy lifestyle by increasing physical activity and improving her dietary habits. Ms. New Patient will require assistance to implement a safe, effective exercise program as her previous attempts have resulted in lower back, and neck pain reducing her to sedentary behaviour within two weeks of commencement.
Ms. New Patient has also reported to me an increase in shortness of breath during exercise, with noknown history of asthma, or any lung / cardiovascular conditions. This was also observedduring thesix-minute walk test, where the patient achieved a 250m walking distance and a peak HRof 162bpm. After exercise she recorded peak flow of 300 L/min. This was 67% of the reference range, based on the client’s age and height (Predicted PEF =450 L/min). I would be grateful if you could further investigate the nature of respiratory limitation and advise me.
E.G.2During the assessment, Mr. Type 2 Diabetes described the self-management of his diabetes. It appears that he is monitoring his diabetes effectively. Mr. Type 2 Diabetes is currently exercising; however, some significant changes can be implemented within his routine to better meet his health needs. We discussed the importance of regular physical activity with a goal ofachieving at least 30 mins of exercise, 5 times per week using a combination of cardiovascular exercise and progressive resistance training concluding each session withsomefull-body stretching.I have also discussed with him some methods for improving exercise adherencein the long-term.
I have recommended that Mr. Type 2 Diabetes, achieve a target heart rate of 121bpm, and not to exceed 136bpm during his cardiovascular exercise program. I have made some amendments to his exercise program which he has now commenced.Mr. Type 2 Diabetes is also aware of exercise contraindications to be considered during exercise participation such as pre-exercise BGL, hypoglycaemia and footwear.
insert patient title, patient surname> is scheduled to see me for a follow-up appointment on the <insert date>. We will be working on insert / describe what you are going to do>.
If you have any questions about this patient please do not hesitate to contact me on <insert contact number>.
Regards,
Insert signature in ink>
<Insert Name>
<Insert Title>
Release Date: 6June 2011
Next Review Date: September 2011