To: Paediatric Dietitian, Children’s Nutrition Service
Date: [today’s date]
Dear Dietitian,
I am referring Emily Carter, a 6-year-old child, for dietary counselling due to concerns about fussy eating and inadequate nutrition.
Emily’s weight is below the 10th percentile for her age. Although otherwise healthy, she refuses vegetables and protein sources, eating primarily pasta and bread. Her parents report frequent fatigue and recurring colds, which may relate to dietary insufficiency.
They are anxious about her growth and long-term health. She would benefit from tailored strategies to encourage food variety and balanced meal planning.
Please provide her parents with practical guidance on managing picky eating and ensuring adequate nutrition.
Yours sincerely,
[Doctor’s Name]
? Sample 8 – Referral for Eating Disorder (Anorexia Nervosa)
Case Notes:
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Patient: Ms. Chloe Williams, 19 yrs
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Weight: 43 kg, Height: 168 cm, BMI: 15.2 (severely underweight)
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Medical history: Diagnosed with Anorexia Nervosa, amenorrhea for 7 months
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Symptoms: Extreme calorie restriction, excessive exercise, dizziness
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Psychological status: Receives psychiatric support, but struggles with food acceptance
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Request: Nutritional rehabilitation, structured meal plan, education on balanced diet
Letter:
To: Specialist Dietitian, Eating Disorder Unit
Date: [today’s date]
Dear Dietitian,
I am referring Ms. Chloe Williams, a 19-year-old patient with Anorexia Nervosa, for urgent nutritional intervention.
Ms. Williams currently weighs 43 kg, giving her a BMI of 15.2. She has experienced significant weight loss and has had amenorrhea for seven months. She engages in extreme calorie restriction and excessive exercise, leading to frequent dizziness.
She is already receiving psychiatric support but continues to struggle with food acceptance. She requires structured nutritional rehabilitation and close monitoring.
I would appreciate your assistance in developing a progressive meal plan, education on balanced eating, and ongoing support for safe weight restoration.
Sincerely,
[Doctor’s Name]
? Sample 9 – Referral for Irritable Bowel Syndrome (IBS)
Case Notes:
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Patient: Mr. Jason Lee, 35 yrs
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Medical history: Diagnosed with IBS, otherwise healthy
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Symptoms: Alternating diarrhoea and constipation, bloating, abdominal discomfort
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Triggers: Reports symptoms worsen after eating dairy, onions, and beans
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Lifestyle: Active, works as a fitness trainer
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Request: Low-FODMAP diet education, practical strategies for symptom control
Letter:
To: Dietitian, Gastroenterology Clinic
Date: [today’s date]
Dear Dietitian,
I am referring Mr. Jason Lee, a 35-year-old patient with Irritable Bowel Syndrome, for dietary assessment and management.
Mr. Lee experiences alternating diarrhoea and constipation, bloating, and abdominal pain. He has noticed symptom flares after consuming dairy, onions, and beans. He is otherwise healthy and physically active in his role as a fitness trainer.
Given his ongoing symptoms, he would benefit from education on the low-FODMAP diet and practical strategies to identify and manage food triggers.
I would appreciate your assistance in providing structured guidance to help improve his quality of life.
Kind regards,
[Doctor’s Name]
? Sample 10 – Referral for Tube Feeding (Post-Stroke Patient)
Case Notes:
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Patient: Mr. Robert Green, 71 yrs
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Medical history: Stroke 3 weeks ago, dysphagia, hypertension
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Current status: Unable to swallow safely, on nasogastric tube feeding
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Weight: 67 kg, stable
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Hospital discharge planned in 1 week
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Request: Long-term enteral feeding plan, carer education, monitoring for nutritional adequacy
Letter:
To: Community Dietitian, Home Nutrition Support Service
Dear Dietitian,
I am referring Mr. Robert Green, a 71-year-old patient recovering from a stroke, for ongoing nutritional support following hospital discharge.
Mr. Green has developed dysphagia and is currently unable to swallow safely. He has been receiving nasogastric tube feeding during his hospital stay, with a stable weight of 67 kg. He is otherwise stable and scheduled for discharge in one week.
He will require a long-term enteral feeding plan, including caregiver education on tube care, feed preparation, and monitoring of nutritional adequacy.
I would appreciate your input in providing a structured tube feeding regimen and ongoing support in the community.
Yours sincerely,
