School Medical Report
[Date]
[Your Company Name]
[Your Company Address]
I. Student Information
Name: [Patient's Name]
Date of Birth: March 15, 2006
Grade: 9
Address: 12 Oak St., Dallas, TX
Emergency Contact
II. Medical History
III. Immunization Record
Vaccine Type | Date Administered |
|---|
MMR (Measles, Mumps, Rubella) | [Date] |
DTaP (Diphtheria, Tetanus, Pertussis) | [Date] |
Varicella (Chickenpox) | [Date] |
HPV (Human Papillomavirus) | [Date] |
IV. Special Health Needs
V. Recent Medical Events
VI. Physical Examination
Examination | Results |
|---|
Last Physical Examination | [Date] |
Height | 5 feet 4 inches |
Weight | 120 lbs |
Vision | 20/20 |
Hearing | Normal |
VII. Recommendations
Ensure patient carries an epinephrine auto-injector at all times due to known allergies to penicillin and peanuts.
Educate teachers and staff about patient's allergies and the necessary steps to take in case of an allergic reaction.
Encourage patient to stay hydrated and take breaks during physical activities to prevent heat-related illnesses.
Monitor patient's seasonal allergies during outdoor activities and provide access to necessary medications as per physician's instructions.
Regularly review and update emergency contact information to ensure prompt communication in case of any medical concerns or emergencies.
Prepared by:
[Your Name]
School Physician
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