Personal Medical Journal Template

Keeping your own medical records is a good idea. A list of all doctors' visits - including dentists and eye doctors is very handy when you need to see dates of immunizations, tests, illnesses, conditions, and surgeries. If you move and have to find a new physician, you easily could provide photocopies of your medical history.  It would be especially handy if you are caring for children or an elderly parent.

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: _________________