Medical Report for Visa

[Date]

I. Patient Information

Name: [Patient's Name]

DOB: [Patient's Date of Birth]

Nationality: American

II. Medical History

A. Previous Medical Conditions

[Patient's Name] has a history of asthma and seasonal allergies but has experienced minimal symptoms over the past five years. There are no records of any chronic illnesses or significant surgeries.

B. Current Medications

Medication	Dosage	Frequency
Albuterol	90 mcg	As needed
Loratadine	10 mg	Once daily

C. Immunization History

[Patient's Name] is up-to-date with routine vaccinations, including tetanus and influenza vaccines.

III. Physical Examination

Measurement	Result	Normal Range
Blood Pressure	120/80 mmHg	90/60 - 120/80 mmHg
Heart Rate	72 bpm	60-100 bpm
Temperature	98.6°F	97.8°F - 99.1°F
Respiratory Rate	16 breaths per minute	12-20 breaths per minute

IV. Laboratory Results

Test	Result	Normal Range
Hemoglobin	14.0 g/dL	13.8-17.2 g/dL
White Blood Cell Count	5,500/mm3	4,000-11,000/mm3
Platelet Count	250,000/mm3	150,000-450,000/mm3
Cholesterol	180 mg/dL	< 200 mg/dL

V. Assessment

Based on clinical evaluation and laboratory findings, [Patient's Name] is in good health and meets the health requirements for the work visa application to [Destination Country]. Overall health is good and he is fit to travel. There are no evident medical conditions that would restrict or complicate his ability to live or work abroad.