Referral Composer

Use this ready-to-copy template to refer patients for specialty ME/CFS evaluation. Edit details as needed. Keep PHI to the minimum required for referral.

Patient Name (optional)

Date of Birth (optional)

Referring Clinician (optional)

Destination clinic

Auto-updates when clinic or patient info changes. You can freely edit the text below before copying.

For health professionals. Informational only — not medical advice. Based on IOM/NAM 2015 criteria and common clinical practices.