Free Printable Fitness to Travel Doctor Note Template
Printable Fitness to Travel Doctor Note
Sunnyvale Medical Practice
123 Wellness Ave Sunnyvale, CA 94086
Date: October 3, 2089
Patient Information:
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Name: Joven
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Date of Birth: March 15, 2055
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Passport Number: A12345678
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Travel Dates: October 10, 2089, to October 20, 2089
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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:
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Blood Pressure: 120/80 mmHg
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Heart Rate: 72 bpm
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Respiratory Rate: 16 breaths per minute
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Oxygen Saturation: 98% on room air
Joven is currently prescribed the following medications:
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Albuterol Inhaler: To be used as needed for asthma symptoms.
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Multivitamins: Daily supplement for general health.
Travel Recommendations:
I recommend that Emily follow these guidelines to ensure her well-being during her travels:
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Medications: Carry him an Albuterol inhaler at all times, particularly when engaging in physical activities or in environments where triggers may be present.
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Hydration: Maintain proper hydration throughout her trip, especially during flights and while exploring Paris.
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Dietary Considerations: Adhere to a balanced diet and avoid known food allergens.
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Health Insurance: Ensure that he has travel health insurance that covers any potential medical needs abroad.
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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
