referral letter 09/08/2014 Dr M McLaren Neurologist Suite 3 67, The Crescent Newtown Dear Dr McLaren Re: Mr Michael Weir DOB: 20/09/1970 I am writing to request further assessment and management of Mr XXX as his clinical signs and symptoms are suggestive of multiple sclerosis. Regarding Mr XXX’s social and medical history, he smokes regularly and reports no time for daily exercise and relaxation. The patient has a history of depression for which he has been taking sertraline hydrochloride since 2012 Recently, Mr XXX presented to the clinic and mentioned that weakness in left leg along with feeling tiredness, sluggishness and stress. During examination, his body mass index was 27.8 and his blood pressure was 90/80 mmhg. His blood reports revealed cholesterol-6.37 and low CBC, RBC, WBC, HB and hematocrit. He was advised to improve his diet, exercise and recreation along with smoking cessation. He was informed to check his hypercholesterolemia in 3 months and advised him to assess his overall health condition. Today, Mr XXX represented to the clinic and reported dizziness, occasional constipation, energy loss, mood swings since last visit, tingling sensation in hands, left leg weakness and two episodes of blackouts for few minutes. He has made changes in diet and exercise. However, he continues his smoking. On examination, loss of sensation noticed on his left and right hands along with diminished left patellar reflux. Therefore, he was advised to perform head and lumbar spinal CT. It would be appreciated if you could assess Mr XXX and please order an MRI if needed.