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

  • Parent: [Parent's Name]

  • Contact: 222 555 7777 | sample@email.com

II. Medical History

• Medical Conditions: None

• Allergies:

  • Medications: Penicillin

  • Foods: Peanuts

  • Environmental: Pollen

• Chronic Medications: None
  

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

• None

V. Recent Medical Events

• None reported

VI. Physical Examination

Examination	Results
Last Physical Examination	[Date]
Height	5 feet 4 inches
Weight	120 lbs
Vision	20/20
Hearing	Normal

VII. Recommendations

1. Ensure patient carries an epinephrine auto-injector at all times due to known allergies to penicillin and peanuts.

2. Educate teachers and staff about patient's allergies and the necessary steps to take in case of an allergic reaction.

3. Encourage patient to stay hydrated and take breaks during physical activities to prevent heat-related illnesses.

4. Monitor patient's seasonal allergies during outdoor activities and provide access to necessary medications as per physician's instructions.

5. 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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