Bert, I have had this problem too. "Cardilogychris" mentions this issue continuing in the 4.x versions. To illustrate: Right click on pt "John Doe", go to - print notes/consultant letters, then letter writer and write a letter to referring provider or consultant. The letter is done as it should, to the provider/consultant. The letter is then saved in the imported items section but under the heading "letter to patient/John Doe". Hope this helps. Thank you in advance for looking into it.