Document for patient after seeing primary care physician.
Providing Clinical Summaries to Patients after Each Office Visit
Who should provide this document to the patient whether within or outside the state?
The primary care physician provides this document to the patient during every clinical visit to the office.
One copy remains in the computer systems/office records and one copy is given to the patient.


What should be included in the Patient Clinical Summary during each office visit to a primary care physician?
Name of the patient: First and last name of patient
Date of birth of the patient: March 22, 1967
Consciousness: Able to answer relevant questions correctly
Pulse Rate: 78
Blood Pressure: 122/80
Temperature: 98.3°F oral temperature
Height: 70.60 inches
Weight: 176 lbs.
Body mass index: 24.99
Problem list: Upper respiratory infection, stress
Visit date: January 10, 2016
Visit location: 5042 N. Winthrop Ave. #237, Chicago, Illinois 60640
Visit provider: Asif Qrueshi, MD
At this point, Doctor Asif Qureshi does not see the patient in person/face to face.
Doctor Asif Qureshi guides existing physicians, medical students, and the public through the Internet guidelines.
Further guidelines can be found at These types of guidelines are more effective.
Follow-up recommendations: Return to the clinic if symptoms persist.
Your care plan and instructions: Instructions were discussed during the visit.
You current allergy list: No known allergies
Test results from past 3 days: None
Orders from today’s visit: No current orders
You self-management goals: What best describes your self-management goals?
Self-management goals put in writing.
No current self-management goals.
Your current medication list: 600 mg of Ibuprofen, 1 by mouth every 6 hours as needed.
500 mg of Amoxicillin, 1 by mouth 3 times a day
Pharmacy: For example, Osco Pharmacy, 5343 North Broadway, Chicago, Illinois 60640 Telephone: (773) 784-1922
The patient gets only this document. This is not a prescription.
This document has facts about the patient on this specific date and time, with prescription (if any).
If any prescription is issued, the prescription is transmitted to the pharmacy nearest the patient’s residence.

When were these resources last updated?
These resources were last updated on February 10, 2016.