Information sheets to help you prepare for your trip to the ER or to a new medical practice.
The pdfs of these sheets can be downloaded here Patient Guide - medical trips.pdf for easy printing.
Medications - current
Name dosage prescribed by to treat what symptom
********************************************************************
NOTES: allergies and notes about reactions to meds should be detailed here.
Medical History:
Illnesses: (be sure to include when you had the illness, treatment for the illness and whether you completely recovered or are still being treated for this illness)
Surgeries: (date, what the surgery treated, was it successful or not? If not, what lasting complications, if any)
Specific test ranges or numbers - standard to you.
HR range:
BP range:
Doctor or medical professional most familiar with your illness
Name__________________________________
Email Address______________________________________
Phone__________________________
Edited by edriscoll
Recommended Comments
There are no comments to display.
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.