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The templates provide structured patient identification placeholders, a concise summary of medical history and specialist follow-up, and a categorized list of prior normal and abnormal testing. They state the current inability to identify a specific genetic etiology, request further evaluation to reach a diagnosis, and include provider contact information and acknowledgement language for review and acceptance.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/adult-pediatric-referral-letter-examples-contacting-vanderbilt-undiagnosed-diseases-program/275415/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/adult-pediatric-referral-letter-examples-contacting-vanderbilt-undiagnosed-diseases-program/275415.png","ImageObject",442,249,{"name":88,"@type":89},"Aladdin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-18","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information do the referral letter examples request for a pediatric patient?","Question",{"text":108,"@type":109},"They request patient identity details, a summary of medical history and specialist follow-up, prior normal testing results, abnormal test findings, and a statement that no specific genetic etiology has been identified yet. They end by requesting referral for further evaluation and listing referring provider contact information.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What information do the referral letter examples request for an adult patient?",{"text":113,"@type":109},"They request patient identity details, an overview of the adult’s medical history and prior genetic evaluation timeline, a description of extensive testing and key results, and a statement that a specific genetic etiology remains unidentified. They then request referral to the program for further evaluation and include provider contact information.",{"name":115,"@type":106,"acceptedAnswer":116},"Why do both templates recommend referral to the Vanderbilt Undiagnosed Diseases Program?",{"text":117,"@type":109},"Both templates explain that current findings cannot be explained by a specific genetic diagnosis despite extensive testing. They request additional evaluation to try to identify a diagnosis and support program acceptance review.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},275415,1790936213,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},2336478503145,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Adult & Pediatric Referral Letter Examples  \nExample 1 (Pediatric):  \nTo Whom It May Concern:  \nWe are writing to you to request consideration of patient, [patient name and DOB], for enrollment in the Undiagnosed Diseases Network (UDN) . [Patient] is a * year old little girl with a history of intellectual disability, hearing loss, exotropia, resolved pulmonary hypertension, and a probable mitochondrial disease. She is followed by multiple specialists at the Monroe Carell Junior Children’s Hospital at Vanderbilt, including Neurogenetics, Cardiology, Developmental Medicine, Neurology, Endocrinology, ENT, GI, and Pulmonology. She is also followed by local pediatrician for routine pediatric care.  \nPrevious normal testing includes: nucSEEK, acylcarnitine profile, urine organic acids, comprehensive metabolic panel, mitochondrial DNA sequencing.  \nAbnormal test results include: EEG consistent with focal epilepsy, ABR, lactate 3.7 ( .5- 2.2) and alanine 755 (152-547) .  \nAt this time, we are unable to identify a specific genetic etiology that would explain the findings seen.  \nWe would like to refer the patient to the Vanderbilt Undiagnosed Diseases Program for further evaluation to try and identify a diagnosis.  \nThank you for your review and consideration for acceptance into the program.  \nPlease do not hesitate to contact our office at *** - *** - **** if you have any questions or require any additional materials.  \n[Referring Provider contact information]  \nExample 2 (Adult):  \nTo Whom It May Concern:  \nWe are writing to you to request consideration of [patient name and DOB], for enrollment in the Vanderbilt Undiagnosed Diseases Program. She is followed by multiple specialists at Vanderbilt University Medical Center.  \n*** is now a 26 years old Caucasian female with a history of severe myopia, high frequency  \nhearing loss, hyperextensible fingers and thumbs, patellar subluxation, aortic dilation with mitral valve prolapse, short fourth metacarpals, bilateral single transverse palmar crease, scoliosis, microcephaly, autism and she has previously had an IQ estimate of 69. She initially presented for a genetic evaluation at the age of 3 years 8 months old for findings of microcephaly, developmental delay and dysmorphic features.  \nSince that time she has undergone extensive testing including plasma amino acids, karyotype, chromosomal microarray, Fragile X, Rett syndrome, homocysteine level, FBNl, TGFBR1, & TGFBR2 gene analysis and most recently a comprehensive Marfan syndrome/Thoracic aortic aneurysm and dissection gene panel containing 22 genes. Her plasma amino acids showed mildly elevated levels of glutamine and glycine, her  \nchromosomal microarray was interpreted as normal but did identify a known CNV (again of 373kb at7qll.23), and her Marfan/TAAD panel found a VUS in NOTCHI (c.2Bl2C>T p.Arg938Trp) .  \nAt this time we are unable to identify a specific genetic etiology that would explain the findings  \nSeen. She has 3 paternal half-siblings and 4 maternal half-siblings, none of  \nwhom have similar findings seen in *** . *** and her parents have been searching for a diagnosis for approximately 22 years and are interested in identifying a diagnosis for her.  \nWe would like to refer *** to the Vanderbilt Undiagnosed Disease Program for further evaluation and to try to identify a diagnosis. Thank you for your review and your consideration for acceptance to the program. Please do not hesitate to contact our  \noffice at (615) *** - **** if you have questions or require any additional materials.  \n[Referring Provider contact information]","cbCaivR2B8LpiyB5","https://ap.wps.com/l/cbCaivR2B8LpiyB5","pdf",85612,"English","# Adult & Pediatric Referral Letter Examples\n## Example 1 (Pediatric)\n## Example 2 (Adult)","[{\"question\":\"What information do the referral letter examples request for a pediatric patient?\",\"answer\":\"They request patient identity details, a summary of medical history and specialist follow-up, prior normal testing results, abnormal test findings, and a statement that no specific genetic etiology has been identified yet. They end by requesting referral for further evaluation and listing referring provider contact information.\"},{\"question\":\"What information do the referral letter examples request for an adult patient?\",\"answer\":\"They request patient identity details, an overview of the adult’s medical history and prior genetic evaluation timeline, a description of extensive testing and key results, and a statement that a specific genetic etiology remains unidentified. They then request referral to the program for further evaluation and include provider contact information.\"},{\"question\":\"Why do both templates recommend referral to the Vanderbilt Undiagnosed Diseases Program?\",\"answer\":\"Both templates explain that current findings cannot be explained by a specific genetic diagnosis despite extensive testing. They request additional evaluation to try to identify a diagnosis and support program acceptance review.\"}]","Adult & Pediatric Referral Letter Examples - Contacting Vanderbilt Undiagnosed Diseases Program | PDF",1789487299]