Template referral letter to Occupational Health Consultant
Re: Name, Address, DOB, Telephone contact details
Dear Dr X
I have made an appointment for you to see Dr (name) on (date) at the Occupational Health
Department OR I am referring Dr (name) to see you in the Occupational Health Department.
Dr X is a (grade) in (speciality).
The reason for referral is due to: (delete as appropriate)
- Long term sickness absence
- Recurrent short term sickness absence
- Concerns regarding behaviour and /or performance at work
(Please give details of their problems including dates of relevant sickness absence)
I have discussed the reasons for this referral with Dr X and have explained the confidential role of the Occupational Health Department.
Following your assessment I would be grateful if you would answer the following questions:
(Please delete as necessary)
- Is Dr X fit for his/her current role?
- If Dr X is not fit, can you give an indication of likely duration of absence?
- Could Dr X's medical problems be contributing to problems with behaviour and /or performance at work?
- Would Dr X be considered to be disabled under the Disability Discrimination Act 1995?
- Can you make any recommendations regarding a return to work plan and /or adjustments or modifications to his/her workplace/role?
- Can you recommend any help or support that the Department can offer Dr X?
- Are there any workplace factors contributing to Dr X's ill health?
Thank you for your help. I look forward to hearing from you.
Yours sincerely
Cc Dr X
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