## Patient Information
* **Name:**[Patient Name]
* **Date of Birth:**[DOB]
* **Passport Number:**[Passport Number]
* **Home Country:**[Home Country]
* **Blood Type:**[Blood Type]
* **Allergies:**[List Any Allergies]
---
## Treatment Overview
* **Procedure:**[Procedure Name]
* **Treating Physician:**[Doctor Name], [Specialization]
* **Hospital/Clinic:**[Facility Name]
* **Treatment Duration:**[Number of Days/Weeks]
* **Expected Recovery Time:**[Recovery Period]
---
## Appointment Schedule
|Date|Time|Activity|Location|Notes|
|---|---|---|---|---|
|[Date]|[Time]|Initial Consultation|[Location]|[Notes]|
|[Date]|[Time]|Pre-procedure Tests|[Location]|[Fasting required]|
|[Date]|[Time]|Procedure|[Location]|[Arrival time]|
|[Date]|[Time]|Post-procedure Check|[Location]|[Follow-up]|
|[Date]|[Time]|Final Consultation|[Location]|[Discharge planning]|
---
## Pre-Procedure Instructions
* [Time] hours fasting before procedure
* Discontinue [medications] [time period] before procedure
* Bring all current medications in original containers
* Wear comfortable clothing with front openings
* Remove jewelry, contact lenses before procedure
* Arrange for an escort post-procedure
---
## Post-Procedure Instructions
* Activity restrictions: [Specific instructions]
* Wound care: [Specific instructions]
* Dietary restrictions: [Specific instructions]
* Follow-up appointments schedule
* Warning signs to watch for
* When to seek immediate medical attention
---
## Medication Tracking
|Medication|Dosage|Schedule|Purpose|Duration|Notes|
|---|---|---|---|---|---|
|[Medicine Name]|[Amount]|[Times per day]|[Purpose]|[Days]|[Special instructions]|
|[Medicine Name]|[Amount]|[Times per day]|[Purpose]|[Days]|[Special instructions]|
|[Medicine Name]|[Amount]|[Times per day]|[Purpose]|[Days]|[Special instructions]|
---
## Healthcare Facility Information
### Primary Hospital/Clinic
* **Name:**[Facility Name]
* **Address:**[Complete Address]
* **Phone:**[Phone Number]
* **Website:**[Website URL]
* **Working Hours:**[Working Hours]
* **Hospital Coordinator:**[Name], [Contact Number]
* **Key Departments:**[Relevant departments and locations]
---
## Recovery Accommodations
* **Name:**[Accommodation Name]
* **Address:**[Complete Address]
* **Room Type:**[Room Details]
* **Check-in:**[Date]
* **Check-out:**[Date]
* **Distance to Hospital:**[Distance in km/miles]
* **Transportation Options:**[Available options]
* **Amenities:**[Relevant to medical recovery]
* **Dietary Services:**[Available food options for specific diets]
---
## Emergency Contacts
### Medical Emergencies
* **Hospital Emergency:**[Emergency number] - Available 24/7
* **Your Doctor:**[Doctor's name] - [Phone number]
* **Medical Coordinator:**[Name] - [Phone number]
### Other Important Contacts
* **Embassy/Consulate:**[Name] - [Phone number]
* **Travel Insurance Emergency:**[Phone number]
* **International SOS:**[Phone number]
* **Local Emergency Services:**[Number e.g., 911, 112, etc.]
* **Taxi/Transportation:**[Number]
---
## Travel Insurance Details
* **Provider:**[Insurance Company]
* **Policy Number:**[Policy Number]
* **Coverage Period:**[Dates]
* **Coverage Amount:**[Amount]
* **Claims Contact:**[Phone Number/Email]
* **Policy Highlights:**
* Medical coverage limit: [Amount]
* Emergency evacuation: [Yes/No]
* Repatriation coverage: [Yes/No]
* Pre-existing condition coverage: [Details]
---
## Local Information
### Currency & Banking
* Local currency: [Currency name]
* Exchange rate: Approximately [Rate] to your home currency
* Nearest ATM: [Location]
* Recommended exchange services: [Names and locations]
### Language Assistance
* Common medical phrases: [List of useful phrases in local language]
* Translation apps: [Recommended apps]
* Interpreter contact: [Name and number if arranged]
### Local Transportation
* Hospital shuttle: [Details if available]
* Reliable taxi services: [Names and contact numbers]
* Public transportation: [Relevant options, accessibility notes]
---
## Patient Notes
[Space for additional notes, questions, or observations during your medical tourism journey]
Patient Information
-
Name:[Patient Name]
-
Date of Birth:[DOB]
-
Passport Number:[Passport Number]
-
Home Country:[Home Country]
-
Blood Type:[Blood Type]
-
Allergies:[List Any Allergies]
Treatment Overview
-
Procedure:[Procedure Name]
-
Treating Physician:[Doctor Name], [Specialization]
-
Hospital/Clinic:[Facility Name]
-
Treatment Duration:[Number of Days/Weeks]
-
Expected Recovery Time:[Recovery Period]
Appointment Schedule
| Date |
Time |
Activity |
Location |
Notes |
| [Date] |
[Time] |
Initial Consultation |
[Location] |
[Notes] |
| [Date] |
[Time] |
Pre-procedure Tests |
[Location] |
[Fasting required] |
| [Date] |
[Time] |
Procedure |
[Location] |
[Arrival time] |
| [Date] |
[Time] |
Post-procedure Check |
[Location] |
[Follow-up] |
| [Date] |
[Time] |
Final Consultation |
[Location] |
[Discharge planning] |
Pre-Procedure Instructions
-
[Time] hours fasting before procedure
-
Discontinue [medications] [time period] before procedure
-
Bring all current medications in original containers
-
Wear comfortable clothing with front openings
-
Remove jewelry, contact lenses before procedure
-
Arrange for an escort post-procedure
Post-Procedure Instructions
-
Activity restrictions: [Specific instructions]
-
Wound care: [Specific instructions]
-
Dietary restrictions: [Specific instructions]
-
Follow-up appointments schedule
-
Warning signs to watch for
-
When to seek immediate medical attention
Medication Tracking
| Medication |
Dosage |
Schedule |
Purpose |
Duration |
Notes |
| [Medicine Name] |
[Amount] |
[Times per day] |
[Purpose] |
[Days] |
[Special instructions] |
| [Medicine Name] |
[Amount] |
[Times per day] |
[Purpose] |
[Days] |
[Special instructions] |
| [Medicine Name] |
[Amount] |
[Times per day] |
[Purpose] |
[Days] |
[Special instructions] |
Healthcare Facility Information
Primary Hospital/Clinic
-
Name:[Facility Name]
-
Address:[Complete Address]
-
Phone:[Phone Number]
-
Website:[Website URL]
-
Working Hours:[Working Hours]
-
Hospital Coordinator:[Name], [Contact Number]
-
Key Departments:[Relevant departments and locations]
Recovery Accommodations
-
Name:[Accommodation Name]
-
Address:[Complete Address]
-
Room Type:[Room Details]
-
Check-in:[Date]
-
Check-out:[Date]
-
Distance to Hospital:[Distance in km/miles]
-
Transportation Options:[Available options]
-
Amenities:[Relevant to medical recovery]
-
Dietary Services:[Available food options for specific diets]
Emergency Contacts
Medical Emergencies
-
Hospital Emergency:[Emergency number] - Available 24/7
-
Your Doctor:[Doctor's name] - [Phone number]
-
Medical Coordinator:[Name] - [Phone number]
Other Important Contacts
-
Embassy/Consulate:[Name] - [Phone number]
-
Travel Insurance Emergency:[Phone number]
-
International SOS:[Phone number]
-
Local Emergency Services:[Number e.g., 911, 112, etc.]
-
Taxi/Transportation:[Number]
Travel Insurance Details
-
Provider:[Insurance Company]
-
Policy Number:[Policy Number]
-
Coverage Period:[Dates]
-
Coverage Amount:[Amount]
-
Claims Contact:[Phone Number/Email]
-
Policy Highlights:
-
Medical coverage limit: [Amount]
-
Emergency evacuation: [Yes/No]
-
Repatriation coverage: [Yes/No]
-
Pre-existing condition coverage: [Details]
Local Information
Currency & Banking
-
Local currency: [Currency name]
-
Exchange rate: Approximately [Rate] to your home currency
-
Nearest ATM: [Location]
-
Recommended exchange services: [Names and locations]
Language Assistance
-
Common medical phrases: [List of useful phrases in local language]
-
Translation apps: [Recommended apps]
-
Interpreter contact: [Name and number if arranged]
Local Transportation
-
Hospital shuttle: [Details if available]
-
Reliable taxi services: [Names and contact numbers]
-
Public transportation: [Relevant options, accessibility notes]
Patient Notes
[Space for additional notes, questions, or observations during your medical tourism journey]