Medical Clearance Report

Medical Clearance Report

Patient Information

Patient Name:

[Your Name]

Patient ID:

123456789

Date of Birth:

January 1, 2050

Gender:

Male

Contact Information:

123-456-7890

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

Examination Details

  • Date of Examination: October 1, 2055

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

  • Specialty: Internal Medicine

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.

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.

Provider’s Signature:

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

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