Health information monthly summary - සෞඛ්‍ය තොරතුරු මාසික සාරංශය:

This page contains up to date health information summary prepared by the member's family doctor ( Gold-Member). The latest summary appears on the top of this page and the old documents at the bottom. This summary is suposed to be updated once in a month. There are seperate columns to upload images of written documents or typed doduments of the same. User can do both or either. But there are more advantages if you update it by typing the given format because in that case your data will be processed soon for decision making. This page is designed to give a quick, brief & logical clinical picture about the member to the clinician who go through this page.Therefore we advice to maintain the flow of this page with up to date information all the time.

This  form  is to be filled by a SLMC registered, MBBS doctor. But the member can copy the written document to the given blank format by typing.If your doctor advice you to attach a copy of a diagnosis card or investigation report etc. to prove below mentioned information, please do it. You can upload those documents to the relevant pages of your health profile very easily.


මෙම කොටස ශ්‍රි ලංකා වෛද්‍ය සභාවේ ලියාපදිංචි MBBS වෛද්‍යවරයෙකු විසින් පමණක් පිරවිය යුතුය. පහත තොරතුරු සනාථ කිරීම සදහා රෝග විනිශ්චය කාඩ් පතක හෝ පරීක්ෂණ වාර්ථාවක පිටපතක් ඇමිණිමට ඔබගේ වෛද්‍ය වරයා නිර්දේශ කළ හෝත් කරුණාකර එය ඉටු කරන්න. මෙම සෞඛ්‍ය ගැටළු සාරාංශය මෙම පිටුවට මාසිකව අනිවාර්යෙන්ම UPLOAD කළ යුතුය. ඊට සපයා ඇති ආදර්ශ පත්‍රිකාවේ පිරවු  IMAGE එකක් හෝ යතුරු ලියනය  (TYPE)  කළ පිටපතක් ලෙස ඔබට එය කළ හැකිය

රෝග විනිශ්චයන්, සෞඛ්‍ය ගැටළු සහ අනෙකුත් අවදානම් සෞඛ්‍ය තත්ව සාරංශය:


HEALTH SCORES - සෞඛ්‍ය -දර්ශක - GRAPH


BLOOD GROUP  -                                    HEIGHT



2.1 HEALTH SCORES  -            YEAR - 


MONTH -           


























BMI - 













RED SCORE -           


























WHITE SCORE -       














SUMMARY - I - සාරාංශය - I | Date - දිනය :___/___/_____|Time -වේලාව : ___:___ AM/PM.-



2.2 PAST PROBLEMS: (i.e. Definitive diagnoses, surgeries, allergies, un-diagnosed abnormalities and risk factors found in the past). Please study the already available medical records. Abnormal past symptoms, past physical signs and past investigatory findings can also be a problem. This problem list must be updated monthly if new or missed problems are revealed during monthly visits.             

Updated on                 Problem          List        Duration orDate of diagnosis                                                                         

Eg :  * Diabetes Mellitus for 10 years   * Dyslipidaemia.for 5 years  

 *  Hypertension for 12 years   *  Hypothyroidism for 2 years ( Hashimoto Thyroiditis)                                            

 * Appendicectomy (in2012)   * Penicillin  Allergy

* Knee joint pain for last 6 months     *  Constipation for last one month             

* Hb = 10g/dl for last 6 months   


SUMMARY - II - සාරාංශය - II - | Date - දිනය :___/___/_____Time -වේලාව : ___:___ AM/PM.


2.3  CURRENT PROBLEMS:(i.e. New definitive diagnoses, surgeries, allergies, un-diagnosed abnormalities found in today’s visit). Abnormal symptoms, physical signs and investigatory findings can also be a problem. Please do not repeat past problems list (Page 2) here again. 

 2.4 OTHER RISK FACTORS: (Found in Pedigree/Family, Social history, Diet, Environment, Occupation, etc.)

Eg : * Family history of IHD, CVA    * BMI (high) = 27.2   * Ex –smoker for 10 years.   * Stressful working environment.*Poor compliance to dietary advices  

 2.5  CURRENT MEDICATIONS : (( Please mention generic names & reasons for changes as far as possible)

(Ex. ORAL - PENICILLINE     500mg     QDS                    5 DAYS)

Route/.Medication/.Dose./Frequency./     Duration


O-  Gliclazide      80mg   BD               All for 01 month

O- Lozartan k+    50mg  BD 

O-Atrovastatin     20mg  Nocte 

O-Thyroxine       100 ug Mane 

O -Zincovit        1 tab     BD

S.C - Mixtard Insulin 15 iuBD 

Name of the Doctor:

Designation & SLMC Reg. Number:


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