Patient Health & Constitution Record
This is your standing health record with our clinic — one copy that you and your practitioner keep current across your whole course of care. It is not tied to any single visit. Update it whenever your constitution, medications, or health status changes, and we will always be treating you from the right picture.
Emergency contact (name & phone):
Constitution Profile (體質)
Predominant constitutional type(s) — updated as the picture clarifies:
Constitution notes — tongue, pulse, cold/heat tendencies, and how the picture has shifted over time:
Chronic Conditions & Western History
Ongoing conditions, past diagnoses, and significant surgeries — with dates where known:
Family medical history relevant to care:
Allergies & Sensitivities
Herb sensitivities or past adverse reactions to TCM formulas:
Food, environmental, or other sensitivities:
Current Medications & Supplements
Prescription and over-the-counter medications, herbal formulas, and supplements — name, dose, and reason. Keep this current so we can watch for herb–drug interactions:
Check any that currently apply — these change what treatment is safe:
Notes on any flag above (dates, details, changes):
Pattern Diagnosis & Treatment Course Log
A cumulative summary maintained by the practitioner — working pattern differentiation (辨證), principal treatment strategies, formulas and point prescriptions used, and how the patient has responded across each course of care. Newest entries at the top.
Add dated entries as things change — new medication, a pregnancy, a life event, a reaction to a formula, a shift in constitution. Newest at the top.
Keep this record current — it is the health picture we treat you from at every visit.