[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-275412-105":53,"doc-detail-275412-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","referralletterexamples-pediatric-example-referral-letters","ReferralLetterExamples - Pediatric Example Referral Letters","","Example pediatric referral letter templates for the Undiagnosed Diseases Network (UDN). The samples request consideration for enrolled patients and siblings, summarize key clinical histories, and document prior diagnostic workups including genetic, metabolic, neuroimaging, and CSF testing. Each letter explains current symptoms and progression, notes results of liver biopsy and molecular testing where relevant, describes ongoing evaluations such as transplant consideration, and concludes with a formal request for UDN review and contact information.",{"@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/referralletterexamples-pediatric-example-referral-letters/275412/",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/referralletterexamples-pediatric-example-referral-letters/275412.png","ImageObject",442,249,{"name":88,"@type":89},"Ben Jamin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-28","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 is the purpose of these pediatric example referral letters?","Question",{"text":108,"@type":109},"They are written to request review and consideration for patient enrollment in the Undiagnosed Diseases Network (UDN), including patients and potentially related siblings.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What types of medical information do the letters typically include?",{"text":113,"@type":109},"The letters summarize patient history and current concerns, then outline prior workups such as genetic testing, metabolic studies, neuroimaging, and CSF studies.",{"name":115,"@type":106,"acceptedAnswer":116},"How do the letters address results that have not provided a diagnosis?",{"text":117,"@type":109},"They state that extensive evaluation has not identified a specific genetic etiology, while emphasizing symptom similarities or patterns that suggest a possible underlying condition needing further UDN evaluation.","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},275412,1790533299,{"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":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":76},2336478466772,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","EXAMPLE REFERRAL LETTERS  \nPEDIATRIC REFERRAL LETTERS  \nPediatric Example Letter \\#1:  \nTo Whom it May Concern:  \nWe are writing to you to request consideration of siblings, [patient names], for enrollment in the Undiagnosed Diseases Network (UDN) . [Patient names] are followed by multiple specialists at [hospital name]. They are also followed by local pediatrician [physician name] for routine pediatric care.  \n[Patient name] is now a [age] year old [gender] with a history of dysmorphic features, failure to thrive, and hepatomegaly of unknown origin. Due to cryptogenic cirrhosis, liver transplant was performed at [age] months of age. Pathology results of [patient name]’s previous liver biopsy was suspicious for a [condition], specifically [specific condition], however, molecular testing for the [gene name] was negative. [Condition] enzyme screening and [condition] screen for the ex planted liver sample came back in the low ranges, but not in the deficiency range usually seen. Additional extensive work-­‐up was unrevealing.  \n[Patient name] is now a [age] month old [gender] noted prenatally to have holoprosencephaly via fetal MRI at [time] weeks gestation. Brain MRI performed on DOL [time] was consistent with [description of MRI] . [He/she] was admitted at [age] months of life for evaluation of liver steatosis, microcephaly, and failure to thrive. At [age] months of age, [patient name] was identified to have new onset hepatomegaly in [month] with vomiting. A liver biopsy from [date] identified [results of liver biopsy] . Due to persistent FTT, G tube was placed in [month] with subsequent fungal peritonitis, now post-­‐[time] day course of [medication] . [Patient name] continues to have daily emesis. [Patient name] is currently evaluated for liver transplantation (persistently elevated transaminases and synthetic dysfunction) .  \nOf note, both siblings have a history of IUGR with failure to thrive, improved for [patient name] following liver transplantation. [Patient name] has a history of developmental delays, making significant progress with therapies, and now within normal limits. [Patient name] continues to have developmental delays and facial features similar to [his/her] [brother/sister] during infancy. Given the similarities in the presentation of these two siblings with an unremarkable family history (parents are not consanguineous), whole exome sequencing was obtained for [patient name] and identified a heterozygous mutation in the [gene name], which in the  \nhomozygous state is associated with [condition] . Subsequent deletion/duplication testing via the MitoMet oligonucleotide array returned as normal. Mitochondrial genome testing via massively parallel sequencing was obtained for [patient name] and was unrevealing.  \nAt this time, we are unable to identify a specific genetic etiology that would explain the findings seen in [patient name] and [patient name] . The presentation of two siblings with similar features, however, is suggestive of a possible autosomal recessive condition, which remains undiagnosed at this time. Parents are interested in identifying a diagnosis, and are also interested in having a third child. We would like to refer these siblings to the Undiagnosed Diseases Network for further evaluation to try and identify a diagnosis. Thank you for your review and consideration for acceptance into the program. Please do not hesitate to contact our office at [phone number] if you have any questions or require any additional materials.  \nSincerely,  \n[Referring provider]  \nPediatric Example Letter \\#2:  \nTo Whom it May Concern:  \nI have followed [patient name] since [age] months of age. [He/she] has a history of significant global developmental delay, [he/she] is nonverbal, has hyperoral behavior, macrocephaly, small stature, [further description] . [He/she] has a great disposition and visually interacts with  \n[his/her] environment. [He/she] has continued to make very slow but steady motor development but ha","cbCaijVpqc3l9LHC","https://ap.wps.com/l/cbCaijVpqc3l9LHC","pdf",78836,8,"English","# Example Referral Letters\n## Pediatric Example Letter #1\n## Pediatric Example Letter #2\n## Pediatric Example Letter #3","[{\"question\":\"What is the purpose of these pediatric example referral letters?\",\"answer\":\"They are written to request review and consideration for patient enrollment in the Undiagnosed Diseases Network (UDN), including patients and potentially related siblings.\"},{\"question\":\"What types of medical information do the letters typically include?\",\"answer\":\"The letters summarize patient history and current concerns, then outline prior workups such as genetic testing, metabolic studies, neuroimaging, and CSF studies.\"},{\"question\":\"How do the letters address results that have not provided a diagnosis?\",\"answer\":\"They state that extensive evaluation has not identified a specific genetic etiology, while emphasizing symptom similarities or patterns that suggest a possible underlying condition needing further UDN evaluation.\"}]","ReferralLetterExamples - Pediatric Example Referral Letters | PDF",1789487293]