Referral Letter Re: Management of Chronic Pain
Dear Dr. I am referring :
for assistance in evaluating his/her chronic pain. I am contemplating the use of opioid pain medication for long term use. In accordance with the Intractable Pain Law of the State of Oregon (ORS 677.470-485), I am requesting your opinion regarding the appropriate treatment of this patient. Relevant clinical notes are attached. Pertinent clinical information is as follows:
. I am asking you specifically to address several questions in the consultation. (ICD 1. The current working diagnosis is Do you concur with this diagnosis, or would you offer a different one? 2. Diagnostic workup has included . Are there other diagnostic measures that you would recommend? ).
3. Current treatment plan includes: . Do you concur with the chronic use of narcotics as noted under treatment plan?
4. Do you request to see the patient again in the future? If so, when and how often?
5. Other . Thank you for seeing this patient in consultation. Please contact me if you need additional information or would like to address this with me personally. Otherwise, I will look forward to receiving your recommendations. Sincerely,