Free template · PDF
Medical report template
A structured report for a solicitor, insurer or employer who asked for one, with the request and its reference at the top.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What is on the form
- Practice letterhead, date and reference
- Patient: name, date of birth, MRN and address
- Requested by, report date and their reference
- Reason for report
- Relevant medical history
- Current medications
- Clinical opinion
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- Keep a copy of the request and the patient's written consent to release the report.
- Answer the questions the requester asked, in their order.
Less paperwork to fill in at all.
In Ask Brigid, consult dictation returns a transcript in the patient record for you to review, next to the diary and the inbox. Practice management for private consultants.
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