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LETTER 5

 Dr Harley Chester

General Practitioners Practice

765 Brunswick Road

Centreville,3072


21 September,2018


Dear Dr Chester

Re:Samuel Harvey,72 years old.


I am writing to refer Mr. Harvey who has been diagnosed with nephrotic  syndrome. He requires follow up of ongoing investigation and management at your Centre.

He requires further referral to Dr Hoffman(Nephrologist) to do further investigations and management of his condition.

Mr Harvey presented to me on 14 September,2018 with complaints of painless swelling of his legs for two months. His swelling has been increased and involved his genitals.In addition, he reported puffiness of face, frothy urine, shortness of breath and bruising of skin.ON assessment, he has signs of fluid overload in the form of pitting oedema of legs,sacrum,external genitalia and ascites.His jugular venous pressure was elevated and BP is 166/98.  On Chest auscultation, findings were consistent with pleural effusion. Subsequently, blood and urine tests were requested .

On his follow up visit today his symptoms persisted and urine analysis revealed 4+ protein. A diagnosis of nephrotic syndrome was made.

In view of above I would appreciate it if you could refer him to nephrologist,Dr Andrew Hofmann ,at City Hospital for renal biopsy to find out the cause of nephrotic  syndrome.


In terms of his past medical history he is hypertensive since/for 13 years and takes atenolol 50 mg once daily.He has had myocardial infarction 4 years earlier.

Regarding his social status, he smokes 30 cigarettes per day and he has a habit of drinking alcohol.  his alcohol intake is above the recommended level. He is married and lives alone with his wife and has no children and is now moving to Centreville to take care of his sick father.Therefore his medical care is being transferred under your supervision.

In view of above I would appreciate if you could refer him to nephrologist,Dr Andrew Hofmann ,at City Hospital for renal biopsy to find out the cause of nephrotic  syndrome.Please contact me if you require any further information. 

Yours sincerely ,

Dr GP.


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