Medicine · Referral letter · Task 4

Memory concerns with incomplete collateral history

You are a GP at Maple Practice. Today is 24 September 2026. Using the case notes, write a referral letter to Dr Sophie Grant, Memory Clinic Consultant, Maple Hospital, 31 Maple Road, Fairford. Request assessment while identifying limitations in the initial test and respecting the patient’s role. Write approximately 180-200 words in the body of your letter.

Patient: Lydia Chen, born 11 October 1950

Case notes

• N01Patient: Lydia Chen; six-month history of missed appointments and repeated questions reported by patient and son; remains independent in personal care.
• N02Current: patient acknowledges misplaced items but feels son exaggerates; no acute change reported; no diagnosis established.
• N03Assessment: initial cognitive assessment completed; score and tool on attached report; hearing difficulty affected two instructions; interpretation requires caution.
• N04Investigations: initial blood results attached; medicine list reviewed; no change today; no known drug allergies.
• N05Collateral: son attended briefly; fuller account not yet obtained; patient consents to clinic contacting son but wants direct involvement in decisions.
• N06Plan: memory clinic assessment; consider fuller history and interpretation of cognitive findings; appointment letter in large print requested.
• N07Practical: son can accompany with advance notice; patient uses hearing aids and should bring them; current address and contact confirmed.
• N08Other: retired surveyor; keeps indoor plants; favourite holiday destination is Cornwall.