<img src="https://app.affine.pro/api/workspaces/qf73AF6vzWphbTJdN7KiX/blobs/lQVUYUiMlQsVUJzQu42qxSH5xLTnKUBDcfs7K4gvuDE=.webp" width="800" height="220" crossorigin="anonymous" /> ## 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 --- ## 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 --- ## 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
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
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]