Medical Report Check Example [Edit & Download]
1. Patient Information
- Name: [Patient’s Full Name]
- Date of Birth: [DOB]
- Patient ID/Record Number: [ID Number]
- Date of Report: [Date]
2. Referring Doctor Information
- Doctor’s Name: [Doctor’s Full Name]
- Specialty: [Specialization]
- Contact Information: [Phone Number, Email Address]
3. Medical History
- Past Medical Conditions: List any relevant medical conditions.
- Surgical History: Include dates and types of surgeries, if any.
- Allergies: Note any known allergies to medications, foods, etc.
- Family Medical History: Summarize relevant family medical background.
4. Current Medications
- List all medications the patient is currently taking, including dosage and frequency.
5. Presenting Complaints
- Describe the symptoms and issues the patient is currently experiencing.
6. Examination Findings
- Vital Signs: Document the patient’s blood pressure, heart rate, temperature, and other vital signs.
- Physical Examination: Note any relevant findings, such as pain, swelling, or abnormalities.
7. Diagnosis
- State the diagnosis based on examination findings, tests, and other evaluations.
8. Investigations and Test Results
- List any diagnostic tests conducted (e.g., blood tests, X-rays) and provide a summary of results.
9. Treatment Plan
- Outline the recommended treatments, including medications, lifestyle changes, or referrals to specialists.
10. Recommendations and Follow-Up
- Provide any additional recommendations, such as rest, therapy, or dietary adjustments.
- Specify when the patient should return for a follow-up visit.
11. Doctor’s Signature
- Doctor’s Name and Signature:
- Date: [Date Signed]
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Medical Report Check Example [Edit & Download]
1. Patient Information
Name: [Patient’s Full Name]
Date of Birth: [DOB]
Patient ID/Record Number: [ID Number]
Date of Report: [Date]
2. Referring Doctor Information
Doctor’s Name: [Doctor’s Full Name]
Specialty: [Specialization]
Contact Information: [Phone Number, Email Address]
3. Medical History
Past Medical Conditions: List any relevant medical conditions.
Surgical History: Include dates and types of surgeries, if any.
Allergies: Note any known allergies to medications, foods, etc.
Family Medical History: Summarize relevant family medical background.
4. Current Medications
List all medications the patient is currently taking, including dosage and frequency.
5. Presenting Complaints
Describe the symptoms and issues the patient is currently experiencing.
6. Examination Findings
Vital Signs: Document the patient’s blood pressure, heart rate, temperature, and other vital signs.
Physical Examination: Note any relevant findings, such as pain, swelling, or abnormalities.
7. Diagnosis
State the diagnosis based on examination findings, tests, and other evaluations.
8. Investigations and Test Results
List any diagnostic tests conducted (e.g., blood tests, X-rays) and provide a summary of results.
9. Treatment Plan
Outline the recommended treatments, including medications, lifestyle changes, or referrals to specialists.
10. Recommendations and Follow-Up
Provide any additional recommendations, such as rest, therapy, or dietary adjustments.
Specify when the patient should return for a follow-up visit.
11. Doctor’s Signature
Doctor’s Name and Signature:
Date: [Date Signed]