Example Study Recommendation Letter #1 (Pediatric) (Page 6 of 8) in pdf

Example Study Recommendation Letter #1 (Pediatric) Page 6

trial of [medication] that did not improve [his/her] symptoms. Dr. [name] most recently requested

a [test] given the [symptoms].

[Patient name] recently developed [symptom] on [his/her] back, which particularly precipitated

the referral to my clinic. I did not feel any sign of excess [hormone]. [He/she] was also evaluated

by dermatology who felt these to be [condition]. Additionally, [he/she] has a [birthmark].

[Patient name] has been seen by several other specialists. [He/she] follows with Dr. [name] at

[hospital] for pulmonary and has been noted to have [symptom]. [He/she] also was briefly

followed by Dr. [name] in [state] at [hospital] for some time, but no further diagnoses were noted.

[He/she] has been evaluated by Cardiology with a normal echo and EKG. [He/she] has also been

evaluated by Physical Therapy, who did not think that [he/she] would benefit from their

intervention due to [his/her] exercise intolerance.

[Patient name]’s family history is of particular interest. [His/her] [Parent] is healthy other than

migraines and is of [ethnicity] background. [His/her] [Parent] is healthy and of [ethnicity] descent.

There is no consanguinity in the family. [Patient name] has [number] siblings. [His/her] oldest

sibling is [age] years old with some slight degree of muscle weakness as well. [He/she] has

[number] healthy child and is currently pregnant with no complications. [Patient name]’s oldest

brother is [age] years old, and his next sibling is [age] years old. Both of them are healthy except

for some asthma and allergies. [Patient name] has an [age]-year old sibling who has joint and

muscle problems that are not as severe as [patient’s].

Thank you for your consideration of [patient’s] application.

Sincerely,

Healthcare provider signature

[Healthcare provider name]

Letter #3, Page 2

Example Study Recommendation Letter #1 (Pediatric) Page 6