Free Printable Medical Records Template
Printable Medical Records
A. Patient Information
|
Full Name: |
Winona Harvey |
|---|---|
|
Date of Birth: |
01/01/2050 |
|
Gender: |
Female |
|
Contact Information: |
222 555 7777 |
|
Address: |
Plano, TX 75023 |
B. Medical History
Winona Harvey has a medical history of hypertension and diabetes. Her family history includes cardiovascular diseases.
C. Current Medications
Winona Harvey is currently taking the following medications:
-
Lisinopril 10 mg, once daily
-
Metformin 500 mg, twice daily
D. Recent Doctor Visits
|
Date |
Doctor |
Reason |
|---|---|---|
|
06/15/2080 |
Dr. [YOUR NAME] |
Routine Check-up |
|
09/10/2080 |
Dr. [YOUR NAME] |
Blood Pressure Follow-up |
E. Test Results
The most recent blood tests show a stable glucose level, but cholesterol levels are slightly elevated, requiring dietary adjustments.
