SYNTHETIC RECORD - Example Redwood Family Medicine - Referral Letter - 2026-07-05
Dear Colleague,
I am referring this 27-year-old man, who carries an established diagnosis of seropositive rheumatoid arthritis confirmed in 2023, for evaluation for Immunara. His hand and wrist swelling has continued to limit his work as a warehouse associate.
He completed roughly six months of oral methotrexate, from January through June 2026, without adequate control of his disease. He has no other significant medical history and takes no other regular medications.
Thank you for your evaluation.
With regards,
The referring primary care physician
Physician note
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SYNTHETIC RECORD - Example Countyline Rheumatology - Office Visit - 2026-06-20
Patient reference SYN-5567. This 27-year-old man with seropositive rheumatoid arthritis was seen for a medication trial review.
He took oral methotrexate for only three weeks in January 2026 before it was stopped because of significant nausea that he could not tolerate. He has not restarted any DMARD since. His joint swelling remains present at the wrists and knuckles bilaterally.
He is interested in discussing Immunara given the brief and poorly tolerated methotrexate trial.
Fax cover
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SYNTHETIC RECORD - Example Redwood Family Medicine - Fax Cover Sheet - 2026-07-06
To: Northstar Choice Pharmacy Benefits
Re: Prior authorization request for Immunara
Patient reference SYN-5567. Member ID: NSC-663217. Pages: 1 of 2.