AFTER-VISIT SUMMARY

[Practice name]
[Phone, hours, and patient portal]

Patient: [Full name]
Date of birth: [Date]
Visit date: [Date]
Seen by: [Clinician's name and role]
Language of this summary: [Language, and the interpreter used at the visit, or none]

WHY YOU CAME IN
[The reason for the visit, in the patient's own words]

WHAT WE FOUND
[Measurements, exam findings, and results reviewed today, in plain words, with the numbers that matter]

WHAT WE THINK IS GOING ON
[Each diagnosis in plain words first, then its medical name, and what it means for the patient]

YOUR MEDICINES
New: [Medicine, what it is for, how much, when to take it, and for how long, or none]
Changed: [Medicine, the old dose, the new dose, and why, or none]
Stopped: [Medicine, and why, or none]
Keep taking: [The patient's other medicines as before, or none]
Side effects to know about: [Common ones that pass, and ones to call about]

TESTS
Ordered today: [Each test, why, when and where to go, and how to prepare, or none]
Your results: [How results will reach the patient, by when, who calls if one needs action, and when to call if they hear nothing]

WHAT TO DO AT HOME
[Two to five steps, each one thing to do, with how much, how often, and for how long]

WHEN TO GET HELP
Call us the same day if: [Symptoms that need a same-day call]
Call 911 or go to the nearest emergency department if: [Symptoms that need emergency care]
After hours: [Nurse line or after-hours number]

YOUR NEXT APPOINTMENT
Next visit: [Date, time, place, and with whom, or when and how to book]
Bring: [Home readings, medicine bottles, forms, or questions]
Referrals: [Who we referred you to, and when they will contact you, or none]
Copy sent to: [Family doctor, specialist, or no one]

Questions? Call [practice phone] or send a message through [patient portal].