Generic Referral - EMIS
Created by
Laura Evans
Specialty
Dentist
Last edited
10/20/2026
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About this template
A reusable referral letter structure for dentists referring a patient to a specialist. It captures the referral urgency, clinical concern, relevant history, examination, investigations, diagnosis, management to date, and the specialist input requested.
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Referral to Trauma and Orthopaedics.
Dear Orthopaedic Shoulder Team,
I am referring Mr David Miller (DOB: 14/06/1972, NHS: 482 910 3847) for further assessment and care under your supervision as a routine referral.
The main reason for this referral is a persistent, symptomatic right full-thickness supraspinatus tear failing conservative physiotherapy management, requiring surgical opinion.
The patient reports right anterolateral shoulder pain and weakness for 4 months following a fall onto an outstretched hand. Night pain is significant, and he is unable to lift his arm above shoulder height. Their relevant medical background includes well-controlled T2DM (on metformin 500 mg PO BID) and a previous contralateral subacromial decompression (2019). Additionally, he works as a self-employed electrician, requires overhead function, and is currently on restricted duties; he is a non-smoker.
On examination, there is mild right supraspinatus fossa wasting. Active ROM is restricted to 80° abduction (painful arc present) and 90° forward flexion; passive ROM is full. Power is 3/5 in abduction and external rotation (lag sign positive). Empty Can and Hawkins-Kennedy tests are positive. Distal neurovascular status is intact.
Investigations completed so far include a right shoulder XR (10/01/2025) showing a type II acromion with no acute fracture or glenohumeral OA, and a right shoulder US (28/01/2025) demonstrating a 1.5 cm full-thickness tear of the anterior supraspinatus tendon with mild subacromial bursitis.
The working or confirmed diagnosis is a right full-thickness supraspinatus tear.
Regarding management, he has completed 8 weeks of targeted rotator cuff strengthening and scapular stabilisation physiotherapy with minimal functional gain. Current analgesia includes naproxen 500 mg PO BID and paracetamol 1,000 mg PO QID PRN.
I would value your specialist advice regarding his suitability for arthroscopic rotator cuff repair given his high functional occupational demands and lack of progress with conservative rehab.
Thank you for reviewing this referral. Please contact me if any further information is needed.
Yours sincerely,
Sarah Jenkins Senior MSK Physiotherapist (First Contact Practitioner) Oakwood Medical Centre, 42 High Street, Bristol, BS1 2AW | Tel: 0117 900 1234
How to use this template
This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.