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Medical Examination Report Document Template

A comprehensive report summarizing findings from a physical or medical examination.

Medical Examination Report

This document provides a comprehensive summary of findings from the physical and/or medical examination conducted for the individual named below. It includes personal information, examination details, medical history, diagnostic results, and physician recommendations.

Patient Information

Full Name Date of Birth Gender Examination Date
{name} {surname} {dateOfBirth} {gender} {examinationDate}

Vital Signs

Height Weight Blood Pressure Heart Rate Temperature
{height} {weight} {bloodPressure} {heartRate} {temperature}

Medical History

{^hasMedicalHistory}

No significant past medical history reported.

{/hasMedicalHistory}

{#hasMedicalHistory}

  • Existing Conditions: {existingConditions}
  • Medications: {medications}
  • Previous Surgeries: {previousSurgeries}
  • Allergies: {allergies}

{/hasMedicalHistory}

Clinical Findings

{clinicalFindings}

Laboratory / Diagnostic Test Results

{#$ tests.length > 0}

Test Name Result Normal Range Remarks
{#tests}{testName}{result}{normalRange}{remarks}{/tests}

{/}

{#$ tests.length == 0}

No laboratory or diagnostic tests were performed.

{/}

Physician's Notes and Recommendations

General Assessment: {generalAssessment}

Recommendations:

{#recommendations}

  • {recommendationText}

{/recommendations}

Physician Information

Name Medical License No. Signature Date
{physicianName} {licenseNumber} {physicianSignature} {reportDate}

This document template includes dynamic placeholders for automated document generation with Documentero.com. Word Template - Free download

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Populate templates with your data and generate Word (DOCX) or PDF documents using data collected from shareable web Forms, APIs, or Integrations.

Use Cases

Automate Medical Examination Report Using Forms

collect patient medical exam data via online form and generate Medical Examination Report
automate pre-employment physical examination report creation from intake form
generate medical fitness report from sports physical evaluation form
create annual employee health checkup report from HR wellness form
fill out Medical Examination Report template using remote patient intake form

Generate Medical Examination Report Using APIs

automatically generate Medical Examination Report via API from EMR system
trigger physical exam report creation from clinic management software using API
generate employee medical evaluation reports programmatically from HR platform
generate Medical Examination Report in real-time from telehealth service via API
use API to create standardized medical checkup reports from wearable device data

Integrations / Automations

automatically create Medical Examination Report from Google Forms via Zapier
generate physical exam reports from Jotform medical submissions using Make
send new patient exam data from Typeform to generate reports in real time
auto-generate Medical Examination Report PDF from Airtable health records
automatically upload generated Medical Examination Report to Google Drive with Zapier

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