Printable Fitness to Travel Doctor Note

Printable Fitness to Travel Doctor Note

Sunnyvale Medical Practice

123 Wellness Ave Sunnyvale, CA 94086
Date: October 3, 2089

Patient Information:

  • Name: Joven

  • Date of Birth: March 15, 2055

  • Passport Number: A12345678

  • Travel Dates: October 10, 2089, to October 20, 2089

  • Destination: Paris, France

To Whom It May Concern,

I, Dr. [Your Name], a licensed physician specializing in Family Medicine, hereby certify that I have conducted a comprehensive medical examination of Joven, born on March 15, 2055. After a thorough assessment, I am pleased to confirm that she is medically fit for travel.

Medical History:

Emily has a well-documented history of mild asthma, which is effectively managed with her prescribed rescue inhaler. She has no known allergies and has completed all necessary vaccinations. Recent blood tests and a physical examination indicate no underlying health issues that would impede her travel.

Current Health Status:

During her examination on October 2, 2089, Joven's vital signs were stable, with the following measurements:

  • Blood Pressure: 120/80 mmHg

  • Heart Rate: 72 bpm

  • Respiratory Rate: 16 breaths per minute

  • Oxygen Saturation: 98% on room air

    Joven is currently prescribed the following medications:

  • Albuterol Inhaler: To be used as needed for asthma symptoms.

  • Multivitamins: Daily supplement for general health.

Travel Recommendations:

I recommend that Emily follow these guidelines to ensure her well-being during her travels:

  1. Medications: Carry him an Albuterol inhaler at all times, particularly when engaging in physical activities or in environments where triggers may be present.

  2. Hydration: Maintain proper hydration throughout her trip, especially during flights and while exploring Paris.

  3. Dietary Considerations: Adhere to a balanced diet and avoid known food allergens.

  4. Health Insurance: Ensure that he has travel health insurance that covers any potential medical needs abroad.

  5. Emergency Contact: Keep a list of emergency contacts and local medical facilities in Paris.

Signature:
Dr. [Your Name], MD
Family Medicine
Medical License Number: 123456789

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