Going to the Doctor

​Going to the Doctor

​Nurse

​Secretary

• ​clinics name: _____

• callers name: _____

• health problem: ____

• how long: ______

• doctors name: ____

• day/time: ______

• ​smoke?

• allergies?

• on a special diet?

• ever had a surgery?

• ever stayed in hospital?​

Yes	​No
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Pharmacist

​Doctor

• ​condition: _______

• doctors concern: ____

• doctors advice: _____​

• suggestion: _______

• ​number of tablets: ______

• when to take: ________

• side effect: _________

• how long: __________​