Wellness Checklist for Patients Template
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Wellness Checklist for Patients
Date: October 15, 2050
1. Health History Review
Health Factor | Notes |
|---|---|
| Last checked on October 5, 2050 |
| Last checked on September 30, 2050 |
| Last checked on September 25, 2050 |
| No history of major diseases (heart, cancer) |
| List of current prescriptions |
2. Preventive Health Screenings
Screening Type | Date Last Done | Next Recommended Date |
|---|---|---|
| March 10, 2050 | March 10, 2055 |
| May 1, 2050 | May 1, 2055 |
| January 12, 2050 | January 12, 2052 |
| February 7, 2050 | February 7, 2052 |
| August 20, 2050 | August 20, 2051 |
3. Lifestyle Habits and Wellness
Health Habit | Current Status | Suggested Improvement |
|---|---|---|
| 30 minutes walking | Increase to 45 minutes |
| Balanced meals | Add more vegetables |
| 7 hours per night | Aim for 8 hours |
| 6 cups of water | Increase to 8 cups |
| Yoga 2 times a week | Add mindfulness practice |
4. Vaccinations
Vaccine Name | Date Last Administered | Next Due Date |
|---|---|---|
| October 1, 2050 | October 1, 2051 |
| March 12, 2050 | March 12, 2055 |
| January 20, 2050 | January 20, 2055 |
| June 15, 2050 | June 15, 2055 |
| July 4, 2050 | July 4, 2051 |
5. Mental and Emotional Health
Concern/Activity | Notes |
|---|---|
| Engaging in weekly counseling sessions |
| No signs of depression at the moment |
| Actively participating in support groups |
| Needs improvement to reduce stress |
| Practicing 10 minutes daily |
Next Steps:
Please schedule your next wellness checkup with [YOUR COMPANY NAME] at [YOUR COMPANY EMAIL] or call [YOUR COMPANY NUMBER] to book an appointment. Make sure to complete any outstanding screenings and consult with your healthcare provider for any updates to your care plan.
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