Patient Medical Statement

Patient Medical Statement

Patient Information

Full Name:

Myron Burton

Date of Birth:

January 1, 2050

Patient ID:

123456

Contact Information:

Springfield, IL 62704

Medical History

  • Diabetes: Diagnosed in 2070

  • Hypertension: Diagnosed in 2075

  • Asthma: Diagnosed in childhood

  • Allergies: Penicillin

  • Surgeries:

    • Appendectomy: 2060

    • Knee Replacement: 2078

Current Medications

  • Metformin 500 mg: Twice daily

  • Lisinopril 10 mg: Once daily

  • Albuterol Inhaler: As needed

  • Levothyroxine 100 mcg: Once daily

Recent Vital Signs and Lab Results

Measurement

Result

Date

Blood Pressure

130/85 mm Hg

September 20, 2083

Hemoglobin A1c

7.2%

August 15, 2083

Cholesterol

Total: 180 mg/dL

August 15, 2083

Weight

180 lbs

September 20, 2083

Physician's Notes

Mr. Myron Burton has shown stable responses to his medication regimen. Blood pressure and blood sugar levels are within acceptable ranges, though continued monitoring is advised. The patient reports occasional shortness of breath, which may be attributed to asthma. Regular follow-ups are strongly recommended.

Signature

[YOUR NAME], Physician

Date: 09/28/2083

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