MEDICAL REPORT DISCUSSION SHEET

THE REPORT
Examination type and date:
Area / side examined:
Report status and date (including any amendment):
Exact sentence I want explained:
Impression / recommendations:
Areas not seen or examination limitations:

MY QUESTIONS
Which area does “unremarkable” describe here?
How does this result relate to my symptoms?
Do other findings or limitations change the next step?
Does this result change any existing follow-up plan?

DISCUSSION AND AGREED FOLLOW-UP
Clinician / service and discussion date:
Explanation in plain language:
Agreed next action and reason:
Who will arrange or complete it:
Expected date / agreed checkpoint:
Who to contact if I have not heard back:
Symptoms or changes the clinician asked me to report:

UPDATE
Action actually completed and date:
Result or response received:
Any remaining question and next contact: