Free Student Medical Health Report Letter Format Template
Student Medical Health Report Letter Format
Greenwood High School
123 Maple Street
Springfield, IL 62701
Phone Number: (217) 555-1234
Email Address: info@greenwoodhs.edu
Date: December 17, 2051
To Whom It May Concern,
Subject: Student Medical Health Report
I am writing to provide a medical health report for Clint Renner, a student enrolled in the 10th Grade at Greenwood High School. This report is intended to provide necessary information regarding the student’s health status, treatment, and any medical accommodations required to ensure their well-being during school activities.
Student Information:
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Full Name: Clint Renner
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Date of Birth: April 15, 2008
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Grade/Year: 10th Grade
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School ID Number: 101234
Medical Diagnosis:
Clint has been diagnosed with asthma, which requires the use of an inhaler during physical activities and when symptoms are triggered by environmental factors such as pollen or extreme physical exertion.
Treatment and Medications:
Clint uses a prescribed inhaler (Albuterol) as needed for asthma management, especially before and after physical activities. He is also advised to carry the inhaler with him at all times in case of sudden symptoms.
Restrictions or Limitations:
Clint should avoid participation in intense physical activities that may trigger asthma symptoms without prior use of his inhaler. He may need to take breaks during physical activities or other strenuous events. He is also advised to avoid exposure to allergens such as pollen or dust during outdoor activities.
Special Accommodations:
Clint may require extra time during gym class to rest and use his inhaler as needed. He should be provided with a quiet, clean space for rest if symptoms occur, and he should be excused from any activities if he feels unwell or short of breath.
Doctor’s Note:
This health report is provided by Dr. Emily Watson, a certified pediatrician. Please feel free to contact me at [Your Name] or [Your Email] for further information or clarification.
This health report is being provided to ensure the student’s health and safety while participating in school-related activities. Should there be any changes to Clint’s condition, I will promptly notify the school administration.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Pediatrician
