Dr. Irene's Health and Nutrition Tidbits

 

 
 

Instruction for Section 1: Summary Health Care Appointments

 

Sorry, the Personal Health Record Binder

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      The purpose of this form is to provide your doctors, at a glance, with an overview of the various members of your health care team that have seen you.  Record all health care appointments in chronological order.  Write down the date, doctor or health care professional you saw, and why.  Keep it brief because either your doctor or you will provide the details of the visit in section 3, Health Care Provider Notes. The last column is a reference column for you to find detailed information.  Record the page number from section 3 so it is easy to find these notes.

 

Example

Sorry, the Personal Health Record Binder

is

 

 

Summary: Health Care Appointment

 

Date

Seen by whom?

Why?

What was done?

Details:

Section 3

Page

9/1/00


Dr. Smith

High Blood Pressure

Given new meds

1

10/1/00

Dr. Smith

Fell, wrist swollen

x-ray

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

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