English Translation of Medical Exam

Letter  Head

Federal District Department of Health

Mexico City

Medical Exam

  1. General Information

Date of Examination:

2/07/15

Patient Name:

John Doe

Sex:

Male

Date of Birth:

September 00, 2000

Address:

123 someplace else

Phone :

123456

Medical Notes of Interest

Front of Page

Sections: 2 & 3

  1. History of Hereditary/Family Conditions:

                No. 14   Rheumatism-  osteoarthritis               meds

  1. History of Personal Pathologies

                No.  8     Cardiopathy-  Hypertension

               

Back of Page

Document Dated Viable:      2/06/15

Doctor’s Stamp:    Dr. Jane Doe , General Practitioner, professional CED

                              123456

Doctor’s Signature:   As shown

Section:  5

      5.   Diagnostics and Observations:

             Male 82 years of age

             Intent of controlled hypertension

 

I ,___________________ , attest to my competency to translate from Spanish to English and certify that this is a correct English translation of all pertinent information from the Spanish original.

Sinature:

Date: