Free Medical Report Format Template
Medical Report Format
Prepared by: [YOUR NAME]
Email: [YOUR EMAIL]
[YOUR COMPANY NAME] | [YOUR COMPANY NUMBER] | [YOUR COMPANY ADDRESS]
Patient Information
In this section, provide the patient's full name, date of birth, and contact information. This information is critical for identifying the individual whose medical history is being documented.
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Patient Name: Philip Mitchell
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Date of Birth: January 5, 1980
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Contact Information: philip@you.mail
Medical History
Summarize the patient's medical history, including any previous diagnoses, surgeries, allergies, and medications. This background is essential for understanding the context of the current medical report.
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Previous Diagnoses: List of Diagnoses
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Surgeries: List of Surgeries
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Allergies: List of Allergies
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Current Medications: List of Medications
Examination Findings
Document the findings from the latest examination. This should include vital signs, physical examination results, and any relevant diagnostic tests that were performed.
|
Date of Exam |
Examiner's Name |
Vital Signs |
Findings |
Notes |
|---|---|---|---|---|
|
January 15, 2050 |
Dr. Malcolm Raynor |
BP: 120/80 |
Normal Heart Rate |
Follow-up in 6 months |
Diagnostic Tests
Detail any diagnostic tests that have been conducted, including the type of test, date performed, and results. This section is important for substantiating claims made in the medical report.
|
Test Type |
Date Performed |
Results |
Interpreting Doctor |
Recommendations |
|---|---|---|---|---|
|
Blood Test |
February 10, 2050 |
Normal |
Dr. Jean Harris |
No action needed |
Treatment Plan
Outline the recommended treatment plan based on the findings from the examination and diagnostic tests. This plan should specify medications, therapies, or further consultations needed.
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Medications: List of Prescribed Medications
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Therapies: List of Recommended Therapies
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Follow-up Appointments: Date and Purpose of Follow-up
Conclusion
In this concluding section, summarize the key points of the report and emphasize the importance of the recommendations made. This ensures that all parties understand the patient’s current health status and next steps.
Signature
Prepared by: [YOUR NAME]
Date: October 23, 2050
