Medical Report Sample For School Example [Edit & Download]

Medical Report for School

Student Information

• Name: Emily Carter
• Age: 12
• Grade: 7
• Date of Birth: August 8, 2011
• Student ID: 12345

Report Details

• Date of Report: October 14, 2023
• Physician’s Name: Dr. Lisa Morgan
• Healthcare Facility: City Pediatric Clinic

Medical History

• Current Conditions: Asthma, Seasonal Allergies
• Past Medical History: No major illnesses or surgeries
• Allergies: Pollen, Dust

Examination Findings

• General Health: Good overall health with controlled asthma.
• Recent Symptoms: Occasional shortness of breath during physical activity, especially in outdoor environments.

Diagnosis

• Primary Diagnosis: Asthma
• Secondary Diagnosis: Seasonal Allergies

Treatment and Recommendations

• Medications:
  • Albuterol Inhaler: As needed before physical activity or when symptoms occur.
  • Antihistamine (Cetirizine) 5 mg daily during allergy season.
• School Accommodations:
  • Access to inhaler during school hours.
  • Limit outdoor physical activities on high pollen days.
• Lifestyle Recommendations: Encourage indoor activities during peak allergy seasons and avoid exposure to dust.

Follow-Up

• Next Appointment: Scheduled for January 14, 2024
• Monitoring: Teachers and school nurse should monitor for asthma symptoms and administer inhaler as needed.