Medical Clearance Report
Medical Clearance Report
Patient Information
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Patient Name: |
[Your Name] |
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Patient ID: |
123456789 |
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Date of Birth: |
January 1, 2050 |
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Gender: |
Male |
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Contact Information: |
123-456-7890 |
Medical History
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Primary Diagnosis: Hypertension
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Secondary Conditions: Asthma (mild), Hyperlipidemia
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Medications:
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Lisinopril 20 mg daily
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Atorvastatin 10 mg daily
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Albuterol inhaler as needed
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Allergies: No known drug allergies
Examination Details
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Date of Examination: October 1, 2055
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Conducted by: Dr. Emily Johnson, M.D.
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Specialty: Internal Medicine
Findings
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Vital Signs:
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Blood Pressure: 128/82 mmHg
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Heart Rate: 72 bpm
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Temperature: 98.6°F
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Respiratory Rate: 16 breaths/min
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Physical Examination:
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General: The patient appears well-nourished and in no acute distress.
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Cardiovascular: Heart sounds normal, no murmurs detected.
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Respiratory: Clear to auscultation bilaterally, no wheezing.
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Abdomen: Soft, non-tender, no masses.
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Extremities: No edema, pulses intact.
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Recommendations
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Clearance Status:
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The patient is cleared for participation in moderate-intensity physical activity, including exercise and recreational sports.
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Additional Recommendations:
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Continue current medications as prescribed.
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Maintain a heart-healthy diet and regular exercise routine.
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Schedule follow-up appointment in 6 months for routine monitoring.
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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
