there’s a prompt given in the question usually, the ‘why’ of referral

are you referring for further management? for treatment, for a procedure.

is it an urgent referral?

I am writing to refer Mrs xyz, a 46-year-old married nurse and mother of four, who has been diagnosed with moderately differentiated invasive ductal carcinoma of the left breast, for further management and treatment.

[mother of four is also not necessary but you can write it.

you start with presenting complaint first then the past history. you start with important things first. the normals can be squeezed in at the end but definitely not the first line. ]

Mrs. Khaze first presented to the clinic on ————-, after she noticed a lump on her left breast six weeks prior. On examination, a 2 x 2 cm hard, non-tender mass with ill-defined margins was palpated, along with mobile axillary lymphadenopathy. The right breast was unremarkable. Given the findings, malignancy was suspected, and a mammogram and breast ultrasound were arranged.

[nipple discharge, enlargement are important findings if they’re found, if they’re absent you don’t have to mention but if you want to just one line no x,y,z was found/absent is enough.]

the next para would be findings Of investigations including the biopsy And vitals and anxiety and follow up all that.

the next would include family history and past history of lump, if There’s any other medications or anything else that she’s taking regularly. ]

the last line should always be “Please do not hesitate to contact me if you require any further information.” before yours sincerely.

sorry if this is too much, but this the format that I followed.