体检介绍信模板英语范文

[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
To Whom It May Concern,
Subject: Authorization for Physical Examination
Dear [Recipient's Name],
I, [Your Full Name], hereby write this letter to formally authorize [Recipient's Name] to conduct a comprehensive physical examination on [Patient's Name], who is currently under my care. As [Patient's Name]’s primary healthcare provider, I am fully aware of the patient’s medical history, current health status, and any specific concerns that may require further investigation.
The purpose of this letter is to provide you with the necessary information and authorization to perform the following examinations and procedures:
1. General Physical Examination: A thorough assessment of [Patient's Name]'s overall health, including vital signs (blood pressure, heart rate, respiratory rate, temperature), height, weight, and body mass
index (BMI).
2. Cardiovascular Evaluation: Examination of the heart and blood vessels, including blood pressure measurements, EKG (electrocardiogram), and
chest X-ray, if deemed necessary.
3. Respiratory Function Test: Pulmonary function tests to assess lung capacity and efficiency, such as spirometry, if indicated.
4. Laboratory Tests: Complete blood count (CBC), blood glucose, lipid profile, thyroid function tests, liver function tests, and urine
analysis, as recommended by [Patient's Name]'s medical history and clinical presentation.
5. Imaging Studies: X-rays, CT scans, MRI, or other imaging modalities as deemed necessary by [Recipient's Name] based on the findings from the physical examination and laboratory tests.
6. Specialty Consultations: Referrals to specialists, such as cardiologists, pulmonologists, endocrinologists, or gastroenterologists, if any specific concerns arise during the examination.
I understand that the physical examination may also include the following:
- Gynecological Examination: For female patients, a gynecological examination will be conducted if deemed appropriate.
- Mental Health Assessment: A brief mental health evaluation to assess for any signs of depression or anxiety, if indicated.
I hereby authorize [Recipient's Name] to perform all the aforementioned examinations and procedures on [Patient's Name] and to make any necessary referrals to specialists. I also authorize the release of all medical information to [Recipient's Name] for the purpose of conducting the examination and for any subsequent treatment or follow-up care.
Please note the following:
- [Patient's Name] has been informed of the nature of the examination and has given their informed consent to undergo the procedures listed above.
- [Patient's Name] has been advised of any potential risks or side effects associated with the examinations and procedures.
- [Patient's Name] has been instructed on how to prepare for the examination, including any dietary restrictions or fasting requirements.
I trust that [Recipient's Name] will exercise due diligence and professionalism in conducting the physical examination and will provide a detailed report of the findings to me. I look forward to reviewing the
results and collaborating with [Recipient's Name] to ensure the best possible care for [Patient's Name].
Should you have any questions or require further clarification, please do not hesitate to contact me at [Your Phone Number] or via email at [Your Email Address]. I am available to discuss any aspect of the examination or treatment plan.
Thank you for your attention to this matter.
Sincerely,
[Your Full Name]
[Your Professional Title]
[Your Healthcare Facility Name]
[Your Healthcare Facility Address]
[City, State, ZIP Code]
[Healthcare Provider's License Number]
[License Issuing State]
cc:
[Patient's Name]
[Patient's Contact Information]。