Medical Clearance Report

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Patient Information

Patient Name:	[Your Name]
Patient ID:	123456789
Date of Birth:	January 1, 2050
Gender:	Male
Contact Information:	123-456-7890

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Medical History

• Primary Diagnosis: Hypertension

• Secondary Conditions: Asthma (mild), Hyperlipidemia

• Medications:

  • Lisinopril 20 mg daily

  • Atorvastatin 10 mg daily

  • Albuterol inhaler as needed

• Allergies: No known drug allergies

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Examination Details

• Date of Examination: October 1, 2055

• Conducted by: Dr. Emily Johnson, M.D.

• Specialty: Internal Medicine

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Findings

1. Vital Signs:

   • Blood Pressure: 128/82 mmHg

   • Heart Rate: 72 bpm

   • Temperature: 98.6°F

   • Respiratory Rate: 16 breaths/min

2. Physical Examination:

   • General: The patient appears well-nourished and in no acute distress.

   • Cardiovascular: Heart sounds normal, no murmurs detected.

   • Respiratory: Clear to auscultation bilaterally, no wheezing.

   • Abdomen: Soft, non-tender, no masses.

   • Extremities: No edema, pulses intact.

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Recommendations

1. Clearance Status:

   • The patient is cleared for participation in moderate-intensity physical activity, including exercise and recreational sports.

2. Additional Recommendations:

   • Continue current medications as prescribed.

   • Maintain a heart-healthy diet and regular exercise routine.

   • Schedule follow-up appointment in 6 months for routine monitoring.

   • Advise patient to seek medical attention if experiencing any chest pain, shortness of breath, or significant changes in health.

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Provider’s Signature:

Dr. Emily Johnson, M.D.
Internal Medicine Specialist

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