Health Info Sheet

Introduction

This Health Info Sheet is designed to provide a comprehensive overview of essential health information for use during medical appointments. It aims to streamline communication between patients and healthcare providers by consolidating important medical details into a single, easy-to-reference document.

Patient Information

Name: [YOUR NAME]
Date of Birth: April 15, 2050
Address: 456 Oak Avenue, Rivertown, TX, 75001
Phone Number: (555) 678-1234
Email: [YOUR EMAIL]

Emergency Contacts

Name	Relationship	Phone Number	Email
Taylor Adams	Spouse	(555) 234-5678	[email protected]
Riley Carter	Parent	(555) 345-6789	[email protected]
Morgan Green	Sibling	(555) 456-7890	[email protected]
Casey Johnson	Friend	(555) 567-8901	[email protected]

Medical History

Primary Care Physician: Dr. Ava Wilson
Medical Conditions: Hypertension, Type 2 Diabetes, Asthma
Surgeries:
- Appendectomy (June 10, 2050)
- Knee Replacement (January 25, 2053)
Hospitalizations:
- Rivertown Medical Center (March 1, 2051 - March 5, 2051)

Medications

Medication Name	Dosage	Frequency	Start Date
Metformin	500 mg	Twice daily	May 1, 2050
Lisinopril	10 mg	Once daily	June 15, 2050
Albuterol	90 mcg	As needed	July 22, 2050
Aspirin	81 mg	Once daily	August 30, 2050

Allergies

Penicillin: Severe rash
Peanuts: Mild gastrointestinal symptoms
Shellfish: Hives

Immunizations

Vaccine	Date Administered	Next Due Date	Provider
Flu Vaccine	October 10, 2050	October 10, 2051	Dr. Ava Wilson
Tetanus	November 15, 2050	November 15, 2055	Dr. Ava Wilson
COVID-19 Booster	December 5, 2050	December 5, 2051	Dr. Ava Wilson
Pneumonia	January 12, 2051	January 12, 2056	Dr. Ava Wilson

Additional Notes

Special Considerations: Requires frequent blood sugar monitoring.
Recent Lab Results: Blood pressure within normal range, A1C level at 7.2%.
Lifestyle Factors: Regular exercise routine, follows a low-sodium diet.

For any updates or changes to this information, please contact [YOUR NAME] at [YOUR EMAIL].