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                                            MEDICAL SUMMARY
                                                       (medical problem list)

Re: ……………………………………………………………………………………(name of the patient)
DOB: ………………………………………………………………………………………………………….
ADDRESS: …………………………………………………………………………………………………..
…………………………………………………………………………………………………………………

Mr./Ms./Mrs. ……………………………(name of the patient) has been a patient of mine for approximately the last five years and was with other partner's of mine in our practice prior to this. Below is a synopsis of his medical problem list.

1.	Non insulin dependent diabetes mellitus. To date, no known organ complications.
2.	Hypertension I. satisfactorily controlled by medication – see below.
3.	Hyperaldosteronism (although he has had difficulty tolerating Spironolactone for this in the past due to a variety of side effects).
4.	Sleep apnea which is treated with nasal CPAP mask.
5.	Mild hepatomegaly and steatosis (verified by liver biopsy in August of ………..date). In years past, he had apparently been given the empiric diagnosis of hemochromatosis based on elevated iron saturation but this was not substantiated by the liver biopsy.
6.	Gastroesophageal reflux/hiatal hernia.
7.	History of mild asthma but really has not required any regular treatment for this.
8.	Family history of coronary artery disease, patient himself had unremarkable cardiac catheterization some years ago (approximately ……………..date) and treadmill test negative for ischemia as recently as previously.
9.	Episode of Bell's palsy within the last two years, now resolved.

SURGERIES:
1.	Tonsillectomy/Appendectomy ………………………………………………..(date/s)
2.	Right knee surgery …………………………………………………………….(date)
3.	Cardiac catheterization in …………………………………………………… (date)
4.	Liver biopsy in ………………………………………………………………… (date)

CURRENT MEDICATIONS:
1.	Glucophage (metformin) 500 mgs 1 tablet bid
2.	Glucotrol (glipizide) 5 mgs 3 tablets bid
3.	Procardia XL (nifedipine) 30 mgs qd
4.	Hytrin (terazosin) 4 mgs qhs
5.	K-Dur (potassium) 20 mEq 2 tablets qd
6.	Actose (pioglitazoni) 30 mgs qd (had discontinued Rezulin (troglitazone) secondary to concern over possible liver damage, although he was never observed to have any problem with this and Avandia (rosiglitazoni) was not very effective.
7.	Avapro (irbesartan) 150 mgs qd (most recently).

NAME AND SIGNATURE: (of attending physician)

ADDRESS: (of the clinic/surgery)

DATE: