I am not sure if I understand your problem.
In my practice when I want to send a referral letter to a specialist, there are 2 ways you can do it
1.After completing my letter I hit the print button and save it as a PDf file and send to my MA's folder with a message thru AC messaging
2 The second way to do it is to hit the EXPORT button next to the PRINT button and save it as a txt file and forward it.
3 I do the same with Labs, Correspondence etc- right click, copy and SAVE to the MA' folder
She then has the ability to combine the Labs,Imaging,Letter as a single PDf file and Fax it to the specialist
Grenville