We created a template to follow -- one that you could easily photocopy or print and use to record your family's visits to health professionals. Your physicians may use it to see health patterns or make critical diagnoses. Keep pages organized by family member in a loose leaf notebook.
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Cut and paste this template into a Word document, save it, and print it when you need to make copies.
Journal of Medical Appointments
Patient Name: __________________________________________________________________________
Date: ____________________
Medical Professional and Type: _____________________________________________________________
Location: _______________________________________________________________________________
Reason for visit: _________________________________________________________________________
Symptoms: _____________________________________________________________________________
Questions: _____________________________________________________________________________
_______________________________________________________________________________________
Diagnosis: ______________________________________________________________________________
Recommendations: ______________________________________________________________________
_______________________________________________________________________________________
Prescribed Medications: __________________________________________________________________
_______________________________________________________________________________________
Tests and Immunizations: ________________________________________________________________
_______________________________________________________________________________________
Reason for and dates of tests: ________________________________________________________________
_______________________________________________________________________________________
Test results and dates: _____________________________________________________________________
_______________________________________________________________________________________
Referrals and follow-up appointments: ________________________________________________________
_______________________________________________________________________________________
Blood pressure: __________________ Height: _________________ Weight: _________________



