Referral letter I am writing to refer Ms XXX, to request further assessment and management at your service. She is due for discharge today. Regarding Ms XXX’s medical and social history, she has a history of moderate dementia, hypertension, and occasional urinary incontinence. She lives with her daughter and sun-in –law. Her daughter is highly concerned about her mother’s health status. The patient requires minimal assistance for her daily activities. On 20/03/2012, Ms XXX was admitted to the hospital and diagnosed with upper respiratory tract infection, dehydration, shortness of breath and bi-basal crackle sound heard on her chest. She mentioned that, she has taken 24 different medications including over the counter medicines as advised by her daughter. During hospitalization, her blood pressure was 150/70. She was commenced on Augmentin 500mg. The patient mentioned dry cough. Ms Peterson was provided some assistance for her daily activities and to maintain her personal hygiene. She was provided a seat walker and wheelchair for her mobility. She is slightly confused. However, she is co-operative. It would be appreciated if you could provide tablet Augmentin 500mg twice daily before Ms XXX’s meals for five days. Please monitor and assist her to take medications Metoprolol 25 mg (BD) and Candesartan 16mg at night. Please provide support to maintain her personal hygiene. Kindly observe and educate her daughter due to the history of polypharmacy.