Medical Report Template

June 23, 2011

A Medical report template represents how a medical report of an individual patient is framed.  This kind of template help doctors to keep records about a patient’s health which might be used for further reference in future if required. They contain the complete details of a patient’s disease found on health assessment.

Sample Medical Report Template

Report prepared for: ______________________________ [mention the name of the person for whom the report is being prepared]

Age: _________

Contact: ____________ [Mention contact number, email or fax of the patient]

Doctor’s name ______________________

Reason for medical assessment: _______________________ [mention the present symptoms of the patient]

Medicines referred ___________________________ [name of all the medicines referred]

Family medical history ____________________ [Mention if any of the parents or close relatives has suffered from any acute diseases]

Past medical history ___________________ [mention patient’s earlier complications if any]

Examination and findings: ________________ [result of patient’s health assessments]

Signature _________________________ [Signature of the person who has prepared the report] Date ____________ [mention the date when the report is being prepared]

Download Medical Report Template in Word Format

Incoming Sample Templates:

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