Individual Medical Record
Health, Personal

tarting from childhood, we have medical records implemented in some type of medical system whether electronic or paper-based. As you go through different insurances, it’s common to switch providers based on either insurance, availability, or distance. Consolidating all of your own medical records help you stay in control of your own health, tracking progress or issues without relying on certain establishments to provide you with any medical records they have. Not to mention the possibility of getting charged a hefty fee for requesting your own medical records. This template helps you track your medical history, doctor’s visits, prescriptions, tests, and procedures undergone. It is your own medical history stored in your own hands, serving as the ultimate tool to help you schedule appointments, identify the last time you got blood work, recall which provider you saw for a certain issue, and so much more.

Although going to the doctor is not often our favorite pastime, it’s a must. Getting routine annual checkups and routine tests completed is key to identifying health issues early on. You never want to be the person that missed all the signs, which your provider or your routine blood labs could have picked up on. Your health is no joke, and staying up to date with all your appointments is important! Sometimes this can be challenging if your provider has very limited availability or if you move to another area.

Fortunately, this template serves to help put you in the driver’s seat of your medical records and your health. Set all appointments necessary with your desired providers. If they aren’t available, pick a secondary provider that can meet your needs. Don’t fall behind on your appointments and staying up to date with your own health. This template organizes all of your data, highlighting previous issues and visits to help you distinguish certain patterns or address health issues. It can keep track of all your prescriptions and medicine previously taken. If you have a negative reaction to a certain medication, jot it down so that if a similar issue arises, you can notify your doctor of your previous reactions.

All the medical details about visits, medicine, and tests you can never remember are logged in this template, giving you ultimate control over your medical history.

Check out some of the features of this template, by table:


When you’re leading a busy life, time has no bounds. It’s hard to keep track of the last time you went to the doctor or had your blood work done. This table tracks all visits and important outcomes of each of those visits. It makes recalling the last time you saw any provider a quick & easy recollection, with plenty of details for each of those visits.


  • Date and time. The date and the time of the doctor visit.
  • Provider NPI. This field links to the Providers table, displaying the NPI of the provider that was seen.
  • Provider seen. This field links to the Providers table, displaying the provider’s name.
  • Reason for visit. This single select drop down indicates the reason for the visit, whether it was a routine visit or something more specific.
  • Notes. Any particular notes regarding the visit that are worth jotting down.
  • Procedure/test. This field links to the Procedures and tests table, identifying the tests that were performed during the visit, if any.
  • Code. This CPT code linked field refers to the procedure code for the procedure itself which is the code that would be seen on the Explanation of Benefits (EOB).
  • Next steps. This field indicates whether there is a follow up visit scheduled, or what the next steps are based on the findings of the current visit.
  • Prescriptions. This field links to the Prescriptions table, displaying which prescription was written during the visit.
  • Test results. This field links to the Test results table, making it easy to find the tests from the specific visit.
  • Completed. A field where you check mark off the visit, indicating that you attended the appointment.


  • All visits. Displays all visits sorted by earliest visit date to latest visit date.
  • Routine. Displays visits that are categorized as routine visits sorted in chronological order.
  • Tests and issues. Displays visits that were scheduled for a test or due to an issue, sorted in chronological order.
  • 2002. Displays all visits in a single year, 2002. This can be incredibly helpful when trying to determine which visits occurred within one calendar year for insurance purposes.
  • Missed appointments. Displays appointments that were scheduled, but you were unable to attend. This view is sorted in chronological order of the scheduled visits. This view is organized in chronological order of the visits.


With no shortage of health issues in the world, it’s no wonder doctors are always busy. It can be difficult to find a doctor that listens to you the way you want to be heard, addresses your concerns, has the availability that matches your same schedule, and is in network with your health insurance. When you do find a provider that fits that criteria, you want to make sure all their details are written down in a safe space where they can’t get damaged. You’d better schedule a visit right away. This table is your perfect virtual post it note with all the doctor’s info required.


  • NPI. The NPI stands for National Provider Identifier, which all domestic providers have. It is their unique identifying number.
  • Name. The name of the provider.
  • Role. The type of provider it is—whether they are a physician, a nurse practitioner, etc.
  • Network. This field links to the Networks table, displaying which network the provider is a part of.
  • Specialty. The field the providers has decided to specialize in, whether that’s dermatology, gynecology, or another field. If they are a primary care doctor, that’s also included in this single select field.
  • Dates seen. This field links to the Visits table, displaying each date when you visited this provider.
  • Extension. If you missed a call and you’re trying to call the provider back, this extension will be the key to not waiting on hold forever.
  • Phone number + extension. This formula field joins the phone number of the facility and the extension of the provider, giving the entire phone number used to contact the provider.
  • Times seen. This field counts the number of times you’ve visited this provider.


  • All providers. Displays all providers sorted in alphabetical order.****
  • Primary care. Displays providers whose specialty is primary care. These doctors can be visited for routine issues. This view sorts the providers in alphabetical order.
  • Previously seen. Displays providers that you have visited in the past. Many providers only book a limited number of new patients per day, so knowing you have already been seen by this provider will likely make scheduling easier. This view is sorted by the highest number of visits to the lowest number of visits for the providers.
  • Specialists. Displays providers that are not primary care doctors sorted in alphabetical order. Think of this as your repository for specialists.
  • Never seen. Displays providers you have never visited. This view is sorted in alphabetical order.


Keep costs low by visiting in network providers that already have pre-negotiated prices your insurance company has agreed to pay for. Certain providers are employed by certain networks as opposed to a specific hospital or clinic. This table lists and networks and which providers fall within those networks.


  • Network ID. The unique Id associated with the network.
  • Name. The name the network identifies with.
  • Phone number. The primary phone number the network uses.
  • Home network location. The location where the providers within this network service patients.
  • Website. The URL for the network’s website.
  • Insurance approved. This field lets to mark off whether this network is accepted by your insurance or if it is considered “out of network”.
  • Provider NPIs. This field links to the Providers table, displaying the NPIs of the providers within network.
  • Provider names. This lookup field pulls the name of the providers for an easier reference to see if your desired provider’s network is accepted by your insurance.


  • All networks. Displays all networks sorted by smallest network ID to highest number.
  • Insurance approeved. Displays all networks that insurance has contracts with and has pre-negotiated prices. This view is sorted in alphabetical order by Network ID.
  • Not approved by insurance. Displays all networks that insurance does not have contracts with and you would be charged out of network charges for. This view is sorted in alphabetical order by Network ID.

Procedures and tests

Even doctors are not able to tell right away what is causing a certain issue. They will often request patients get their labs done, urine tested, and take a variety of other tests if they have further questions. This this table contains all tests you have previously taken or procedures you have undergone. If you can’t remember what happened the last time you had strep, this table will tell you what test was done to determine whether the infection was the cause of your issue, or if a further test is required.


  • CPT code. The current procedural terminology. The code medical providers use to bill for certain procedures. It’s the unique code associated with certain tests administered.
  • Procedure. The name of the procedure or test.
  • Description. A brief description of the test.
  • Doctor visits. The dates where the specific test or procedure was administered.
  • Severity. This rating field lets you indicate how serious the procedure is. Routine blood work would get a very low rating, while wisdom tooth extraction would get a higher rating.


  • All procedures. Displays all tests and procedures sorted in alphabetical order.
  • Intensive. Displays tests and procedures with a severity level of 4 or 5 sorted in alphabetical order.
  • Minor. Displays tests that are minor and require minimal effort sorted in alphabetical order.

Test results

What’s really going on? This table identifies irregularities and issues with your test results, aiding you and your provider on your quest to determine the root cause of an issue. This table also displays all the tests that came back completely normal and are nothing to worry about.


  • Identification number. The unique ID related to the results.
  • Date tested. This field links to the Visits table, displaying the exact date this test was administered on in year/month/day format.
  • Administered by. This lookup field looks to the Visits table to displays the provider that administered the test.
  • Results. This field allows you to upload a copy of the results themselves.
  • Test. This field links to the Visits table, displaying the test was performed on the date.
  • Concerns. In this field, all issues or results that are out of range should be displayed. If white blood cell count is too elevated, that would be displayed here. When looking at tests, you want to know what’s wrong rather than spending time running through all the things that are normal and don’t require attention.
  • Notes. Additional notes go here. If one result is slightly out of range but nothing to worry about, that note would go in this field.
  • Requires attention. This boolean field lets you select whether the results of your test require further attention or action on your part.


  • All results. Displays all test results sorted by Identification number.
  • Concerning. Displays results that have concerns or out of range fields sorted by identification number.
  • Require action. Displays test results that require action or some type of change, sorted by identification number.


There are certain medicines that you cannot purchase over the counter because they require a prescription. This table includes all the prescriptions your provider has given you directly or has sent over to a pharmacy. It’s critical that you stay on top of all prescription medication you are taking to avoid undesired side effects when taking more than one prescription.


  • Prescription ID. The unique ID associated with the prescription.
  • Name. The name of the medicine the prescription is for, selected from the Medicine table.
  • Reason for taking. The primary reason the medicine was prescribed.
  • Prescribed on. This field links to the Visits table, displaying the date the prescription was written.
  • Prescribed by. This field also looks to the Visits table to automatically display the provider that sent in the prescription.
  • Dose. The concentration of each pill in milligrams.
  • Frequency. The frequency at which the provider directed you take the medicine. Is it twice a day? Once every six hours?
  • Refills. The number of refills that doctors has allowed.
  • Duration. The amount of time the doctor indicated you should continue taking the medicine. This could be until symptoms subside, or for a standard 14 days.
  • Instructions. This formula field ties in all necessary info when determining how often the medicine should be consumed.


  • All prescriptions. Displays all prescriptions sorted by prescription ID.
  • Refillable. Displays prescriptions that can be refilled sorted by prescription ID.
  • Symptom treatment. Displays prescriptions that are meant to be taken until the symptoms subside, not a set number of days sorted by prescription ID.


Between allergy medicine and very specific antibiotics, it can be tricky to remember each medicine’s side effects. Maybe at some point you did try out one medicine and it made you feel pretty sick, but you don’t remember the name of the medicine. Avoid those situations by logging all medicine taken using this table. Easily pull up side effects and avoid taking medicine that your body has rejected in the past.


  • Name. The name of the medicine.
  • Common uses. Situations where the medicine is most commonly used.
  • OTC. This field should have a check mark if you can purchase the medicine without a prescription (over-the-counter).
  • Take with food. Does this medicine need to be accompanied by food? If so, check the box.
  • Side effects. This multi-select field displays all the common side effects of the medicine.
  • Prescriptions. This field links to the Prescriptions table, displaying the prescription ID of when this medicine was prescribed.
  • Notes. Any interactions with the medicine should be noted here.


  • All medicine. Displays all medicine sorted in alphabetical order.
  • Over the counter. Displays medicine that can be purchased over the counter in alphabetical order.
  • Bowel-related side effects. Displays medicine that can impact your bowel movement due to the side effects, sorted in alphabetical order.
  • Sleep-affecting. Displays medicine that can make you drowsy throughout the day or medicine that can lead to insomnia. This view is sorted in alphabetical order.
  • Require food. Displays medicine that requires you to eat food prior to taking the medicine, sorted in alphabetical order.