Free Medical Statement Template
Medical Statement
Patient Information
|
Field |
Details |
|---|---|
|
Full Name |
Sandy Patel |
|
Age |
45 |
|
Gender |
Female |
|
Address |
Louisville, KY 40218 |
Medical History
-
Hypertension
-
Diabetes Mellitus Type II
-
Hyperlipidemia
Current Medications
-
Lisinopril - 10 mg daily
-
Metformin - 500 mg twice daily
-
Atorvastatin - 20 mg nightly
Allergies
-
Penicillin
-
Sulfa drugs
Recent Lab Results
|
Test |
Result |
Reference Range |
|---|---|---|
|
Hemoglobin A1c |
6.8% |
4.0-5.6% |
|
LDL Cholesterol |
130 mg/dL |
<100 mg/dL |
|
Blood Pressure |
145/90 mmHg |
<120/80 mmHg |
Notes
The patient exhibits controlled symptoms with the current medication regimen but requires further interventions to manage blood pressure and cholesterol levels. Regular follow-up is recommended to monitor progress and adjust treatments as necessary.
Signature
[YOUR NAME], M.D.
Date: 05/16/2060
