Free Medical Records Summary Template
Medical Records Summary
PATIENT INFORMATION
|
Field |
Information |
|---|---|
|
Name |
Amelia Pagac |
|
Date of Birth |
05/12/2050 |
|
Gender |
Female |
|
Address |
Tampa, FL 33601 |
|
Contact Number |
222 555 7777 |
|
|
amelia@you.mail |
MEDICAL HISTORY
|
Category |
Details |
|---|---|
|
Allergies |
Penicillin, Nuts |
|
Chronic Conditions |
Type 2 Diabetes, Asthma |
|
Past Surgeries |
Appendectomy (2075) |
|
Medications |
Metformin, Albuterol |
|
Family Medical History |
Father: Heart Disease, Mother: Osteoporosis |
RECENT VISITS
|
Date |
Reason for Visit |
Diagnoses |
Treatment Plan |
|---|---|---|---|
|
02/14/2089 |
Persistent cough, fatigue |
Bronchitis |
Antibiotics, rest, follow-up in 2 weeks |
|
01/10/2089 |
Routine check-up |
None |
Maintain diet and exercise routine |
TEST RESULTS
|
Test Name |
Date Conducted |
Result Summary |
|---|---|---|
|
Complete Blood Count |
02/12/2089 |
Normal |
|
Chest X-Ray |
02/13/2089 |
Mild inflammation in lungs |
CURRENT STATUS
|
Field |
Details |
|---|---|
|
Primary Physician |
Dr. Emily Carter |
|
Ongoing Concerns |
Controlled asthma symptoms |
|
Current Treatment |
Using inhaler as needed |
|
Next Appointment |
03/01/2089 |
NOTES
Patient is adhering to treatment plans effectively. Recommended follow-up for diabetes management scheduled for 04/15/2089.
Prepared By: [YOUR NAME]
[YOUR COMPANY NAME]
Date: 02/15/2089
