Current concerns and history
- Main health concerns you want your healthcare team to know about
- Relevant conditions or health history
Free printable PDF
Health Record Summary Sheet
Create a concise current snapshot of selected health information for healthcare discussions.
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What it helps organize
Current health snapshot
Keep important current information in one summary
This printable gives you a structured place to record selected concerns, history, medicines, recent information and healthcare contacts.
It is a personal summary rather than a complete medical record, and it does not verify or interpret the information entered.
What is included
Four-page health summary
Inside the printable
Medicines and reactions
- Prescription medicines, strengths, schedules and notes
- Over-the-counter medicines, vitamins and supplements
- Allergies or adverse reactions
Recent information
- Relevant thyroid history
- Selected recent laboratory results with dates and reference ranges
- Recent symptoms or changes
Healthcare team and communication
- Healthcare-team roles, names, organizations and contact details
- Other information for your healthcare team
- Communication or accessibility needs
How to use it
Keep the summary current and concise
Record information as it was communicated to you or shown in your existing records. Include only the details that feel relevant for the healthcare discussion you are preparing for.
Review the summary before using it and update anything that has changed. Bring supporting records when more detail may be needed.
Frequently asked questions
Health-summary questions
Is this a complete medical record?
No. It is a concise personal summary of selected information and does not replace official records held by healthcare providers.
Should I include every past condition or test?
Not necessarily. Include the information you consider relevant and confirm uncertain details with your healthcare team or existing records.
Does the worksheet interpret laboratory results?
No. It provides space to copy selected results and reference ranges without explaining what they mean.
Is an online version available?
Not at launch. This resource is designed to be printed and completed by hand.
Printing tips
Before you print
Printing your worksheet
- Select US Letter paper.
- Print at 100% or Actual Size unless your printer requires a different setting.
- Use portrait orientation.
- Check the print preview before printing.
- Print another blank copy whenever you need one.
- Store completed pages somewhere you are comfortable keeping personal health information.
Personal use
Free for your own records
Free for personal, non-commercial use. Please do not resell or redistribute the files.
Privacy note
Keep completed copies where you choose
This printable may contain personal health information after you complete it. Store printed copies where you are comfortable keeping them and share them only with people you choose.
Community
Learn moreWant to learn from other people’s experiences?
Join the Hypothyroidism Advice & Support Group, an active Facebook community with more than 11k members.
Lifestyle
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For personal organization only. This worksheet is not medical advice, a diagnostic tool or a substitute for care from a qualified healthcare professional.