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HTML Preview Hospital Medical Report page number 1.
1
Hospital Medical Report
This form is to be co
m
pleted
by the patient’s hospital docto
r
Private & Confiden
tial
Patient’
s
Na
m
e
Date of birth
Ward
Hospital
Consultant
Dear Doctor
The above p
atient, who is currently an in
-patient under your care,
is due to be admitted to
one of our care ho
m
es. In order
that
we can safely look after hi
m/her, we need you to send us infor
m
ation about his/
her medical history.
Please can yo
u send a discharge summary, includ
ing the following info
rm
ation:
When were the
y admitted to your hospital?
Reason for a
dm
ission and medica
l diagnosis
Past medical history (
if known)
Progress on w
ard
Current clinical condition
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