Free Sample Patient Medical Record Template
Sample Patient Medical Record
[YOUR COMPANY NAME]
Patient Information
|
Name: |
Beverly Haley |
|---|---|
|
Date of Birth: |
01/01/2051 |
|
Gender: |
Female |
|
Contact Number: |
222 555 7777 |
Medical History
Beverly Haley has a history of hypertension and diabetes mellitus. She underwent appendectomy in 2075 and has no known drug allergies. Recent blood tests indicate elevated cholesterol levels.
Current Medications
-
Lisinopril 10mg once daily
-
Metformin 500mg twice daily
-
Atorvastatin 20mg once daily
Recent Visits
|
Date |
Reason for Visit |
Physician |
|---|---|---|
|
10/15/2083 |
Routine Check-up |
Dr. [YOUR NAME] |
|
08/08/2083 |
Blood Pressure Follow-up |
Dr. [YOUR NAME] |
Laboratory Results
Most recent laboratory results from 09/20/2083 show the following values:
|
Test |
Result |
Normal Range |
|---|---|---|
|
Hemoglobin A1c |
7.2% |
4.0% - 5.6% |
|
Total Cholesterol |
240 mg/dL |
Less than 200 mg/dL |
Plan
Beverly Haley is advised to continue her current medication regimen. Recommended lifestyle modifications include a low-sodium, low-sugar diet, and engaging in at least 30 minutes of exercise daily. Follow-up visit scheduled for 12/15/2083 to reassess treatment efficacy and manage any new or ongoing health concerns.
