如情況危及生命，請立即致電 999 或前往 急症室（A&E，Accident & Emergency）。
如不確定應求醫方向，請致電 NHS 111。
If the situation is life-threatening, call 999 immediately or go to A&E (Accident & Emergency).
If you are not sure where to seek help, call NHS 111.
先整理，再求診。臨入房先諗，最容易漏重要資料。
Prepare first, then attend the appointment. It is easy to forget important details under pressure.
這些表格只供你自行列印、手寫及保管。英醫路不會收集、儲存或查看你的任何個人健康資料。內容只協助你整理資料，方便和 家庭醫生（GP）、藥劑師、NHS 111 或其他醫護人員溝通；它們不是診斷工具、醫療建議或治療建議。
These forms are for you to print, fill in by hand and keep yourself. HealthRoad England does not collect, store or view any of your personal health information. The forms are only for organising information and helping communication with a GP, pharmacist, NHS 111 or other healthcare professionals. They are not diagnostic tools, medical advice or treatment recommendations.
- 每張表都可單獨列印。
- 每張表都已加入英醫路 logo，適合 A4 黑白列印。
- 你不需要全部印出來，只選最適合自己情況的表格即可。
- Each form can be printed separately.
- Each sheet includes the HealthRoad England logo and is designed for A4 printing.
- You do not need to print everything — only choose the forms that fit your situation.
表格一覽Form library
下方共 12 款可列印表格，涵蓋 GP 預約準備、移英醫療資料清單、症狀、就診問題、覆診跟進、藥物清單、家中讀數、兒童、陪診者、抽血預約清單及醫療摘要。你可先看簡介，再按需要列印個別表格。
There are 12 printable forms below, covering GP appointment preparation, moving-to-England medical records, symptoms, questions, follow-up notes, medication lists, home readings, children, carers, blood test appointment checks and a medical summary sheet. Read the summary first, then print only the forms you need.
新增：GP 預約準備一頁表New: GP Appointment Prep Sheet
把「今日最想處理的事」、時間線、藥物、過敏、想問的問題和需要跟進事項放在同一頁。Put your main concern, timeline, medicines, allergies, questions and follow-up needs on one page.
新增：搬英醫療資料清單New: Moving Medical Records Checklist
按「移英前」、「抵達後」和「給 GP 前」整理藥物、過敏、疫苗、病歷、NHS App 和 NHS 編號。Organise medicines, allergies, vaccines, records, NHS App and NHS number before and after moving.
1. 症狀記錄表1. Symptom record
記下何時開始、不適程度、頻率、誘因及已試過的方法。Record when symptoms started, how severe they are, frequency, triggers and what you have already tried.
2. 問題清單2. Question list
進入診症室前，先記下希望詢問 家庭醫生（GP）或 藥劑師的問題。Write down what you want to ask a GP or pharmacist before the appointment.
3. 覆診跟進表3. Follow-up notes
記下醫護說明、檢查安排、轉介、覆診時間及回家後需要處理的事項。Record advice given, tests arranged, referrals, follow-up dates and what to do afterwards.
4. 藥物清單4. Medication list
方便整理現時服用藥物、劑量、時間、開立處方來源及過敏／不適反應。Useful for keeping current medicines, doses, timing, who prescribed them and any allergy or side effects.
5. 家中讀數記錄表5. Home readings record
適合記錄體溫、血壓、血氧或其他讀數，之後向醫護人員描述情況。Record temperature, blood pressure, oxygen saturation or other readings to discuss with healthcare staff later.
6. 兒童求診記錄表6. Child appointment record
適合記錄發燒、食慾、飲水、精神、尿片／如廁等情況。Useful for tracking fever, appetite, fluids, energy and nappies / toilet frequency.
7. 陪診者記錄表7. Carer / companion notes
適合陪同家人求診時，整理日常狀況、照顧安排及希望代為提問的重點。Useful when accompanying a family member and needing to summarise daily condition, support needs and key questions.
8. 搬來英格蘭前醫療資料整理表8. Medical information before moving to England
整理既往病史、手術、疫苗、過敏、長期藥物及重要報告，方便 登記家庭醫生 或第一次求診。Organise past diagnoses, surgery, vaccines, allergies, long-term medicines and key reports for GP registration or first appointments.
9. 抽血預約 清單9. Blood Test Appointment Checklist
出門前確認誰開單、是否需要紙本表格、結果會返去誰、誰會解釋。Check who requested the test, whether you need a paper form, where results go and who explains them.
10. 一頁醫療摘要10. One-page Medical Summary
把藥物、過敏、長期病、手術、重要報告和今日問題整理成一頁。Summarise medicines, allergies, conditions, surgery, key reports and today's issue on one page.
GP 預約準備一頁表GP Appointment Prep Sheet
適合看家庭醫生（GP）前，把最重要資料放在一頁，帶去診所、電話或視像預約時使用。Use this before a GP appointment to keep the most important information on one page.
這張表只協助你整理資料和問題，不會判斷病情，也不取代家庭醫生（GP）、NHS 111 或其他醫護人員的意見。如情況危及生命，請立即致電 999。
This sheet only helps you organise information and questions. It does not assess symptoms or replace advice from a GP, NHS 111 or other healthcare professionals. If life is at risk, call 999.
| 如何清楚說明情況How to explain clearly | 手寫記錄Your notes |
|---|---|
| 症狀／問題是甚麼？What is the symptom / issue? | |
| 何時開始？持續多久？When did it start? How long has it lasted? | |
| 有沒有變嚴重或影響睡眠、進食、上學、工作？Is it getting worse or affecting sleep, eating, school or work? | |
| 已試過甚麼？例如休息、非處方藥、藥房建議。What have you already tried? Rest, over-the-counter medicine, pharmacy advice? | |
| 現有藥物、補充品、藥物過敏或不良反應。Current medicines, supplements, allergies or adverse reactions. |
| 今日想問的 3 個問題Three questions to ask today |
|---|
| 可能需要跟進的事項Possible follow-up needs | 是／否／備註Yes / no / note |
|---|---|
| 病假紙（Fit Note）Fit Note | |
| 藥物或處方覆核Medicine or prescription review | |
| 檢查、驗血、轉介或報告解釋Tests, blood test, referral or result explanation |
| 預約後：醫護說明的下一步After the appointment: next steps given |
|---|
搬英醫療資料清單Moving to England Medical Records Checklist
適合移居前後整理資料，方便登記家庭醫生（GP）、第一次看診或向藥房查詢。Use this before and after moving to organise information for GP registration, first appointments or pharmacy questions.
這張清單只整理行政與文件資料，不代表你必須翻譯所有病歷，也不判斷你是否需要看醫生。緊急或不確定情況，請按情況使用 999、急症室（A&E）或 NHS 111。
This checklist only organises documents and practical information. It does not mean you must translate every record and it does not decide whether you need medical care. In an emergency or if unsure, use 999, A&E or NHS 111 as appropriate.
| 移英前先整理Before moving | 已準備？Prepared? | 備註Notes |
|---|---|---|
| 一頁醫療摘要：長期病、手術、住院、重要診斷。One-page summary: conditions, surgery, hospital stays, major diagnoses. | ||
| 現有藥物清單：藥名、劑量、每日幾次、用途。Current medicine list: name, dose, frequency and use. | ||
| 藥物包裝／藥袋相片，保留英文通用名如有。Photos of medicine boxes / labels, including generic names if available. | ||
| 過敏、嚴重不良反應、曾經不能使用的藥物。Allergies, serious adverse reactions or medicines to avoid. | ||
| 疫苗紀錄，尤其兒童、青少年、孕婦或準備懷孕人士。Vaccination records, especially for children, teenagers, pregnancy or planning pregnancy. | ||
| 最近重要報告或專科信件副本。Recent key reports or specialist letters. |
| 抵達英格蘭後After arriving in England | 已處理？Done? | 備註Notes |
|---|---|---|
| 用官方 NHS 搜尋工具找附近家庭醫生診所（GP surgery）。Use the official NHS search tool to find nearby GP surgeries. | ||
| 申請登記家庭醫生（GP）。如未有 NHS 編號，也仍可先登記。Register with a GP. You can still register even if you do not yet know your NHS number. | ||
| 登記後留意 NHS 編號、診所訊息和如何使用 NHS 應用程式（NHS App）。After registration, note your NHS number, surgery messages and how to use the NHS App. | ||
| 先問診所接受哪種方式提交海外病歷：紙本、副本、網上表格或預約時帶同。Ask how the surgery accepts overseas records: paper copy, duplicate, online form or bring to appointment. | ||
| 原件自己保管，通常先交副本或簡短摘要較安全。Keep originals yourself where possible and provide copies or a concise summary. |
| 家庭成員／兒童特別資料Family / child details |
|---|
| 兒童疫苗紀錄、出生資料、長期藥物、學校需要知道的健康資料。Child vaccination records, birth information, long-term medicines and health details school may need. |
| 長者或家人：照顧者資料、日常功能、常用藥房、過敏及緊急聯絡人。Older relatives or family: carer details, daily function, usual pharmacy, allergies and emergency contacts. |
| 日後可能要問診所Questions to ask the surgery later |
|---|
| 我應該如何提交海外醫療紀錄？How should I submit my overseas medical records? |
| 我可以在 NHS App 查看哪些紀錄？What records can I view in the NHS App? |
| 如果長期藥物快用完，應如何查詢？If long-term medicines are running low, how should I ask? |
症狀記錄表Symptom Record Form
適合在看 家庭醫生（GP）、藥房或 NHS 111 前，先整理自己近來的不適情況。Useful before seeing a GP, visiting a pharmacy or calling NHS 111.
這張表只協助你整理資料，方便與醫護人員溝通，不是診斷工具，也不能代替醫療建議。
This form is only for organising information and helping communication with healthcare professionals. It is not a diagnostic tool and does not replace medical advice.
| 日期／時間Date / time | 症狀／位置Symptom / location | 嚴重程度（1–10）Severity (1–10) | 有無誘因／加重情況？Triggers / what makes it worse? | 已試過甚麼？What have you already tried? |
|---|---|---|---|---|
家庭醫生（GP）／藥劑師 問題清單GP / Pharmacist Question List
先記下希望詢問的事項，進入診症室時較不容易忘記。Write down your questions first so you are less likely to forget them during the appointment.
可用於 家庭醫生（GP）、藥房、覆診或電話諮詢前準備。
Useful before a GP appointment, pharmacy visit, follow-up or telephone consultation.
| ## | 我希望詢問的問題Question I want to ask | 已答？Answered? |
|---|---|---|
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 |
預約 跟進記錄表Appointment Follow-up Notes
覆診或看完醫生後，整理下一步安排，避免回家後忘記。Use this after an appointment to note the next steps so nothing is forgotten later.
| 醫護人員說了甚麼？What did the healthcare professional say? |
|---|
| 下一步安排Next steps |
|---|
| 要跟進的日期／事項Dates / actions to follow up |
|---|
藥物清單Medication List
整理現時使用藥物，帶去 家庭醫生（GP）、藥劑師或 醫院預約。Organise current medicines to bring to a GP, pharmacist or hospital appointment.
這張表只作整理用途，不能判斷你應否服藥、服多少或何時服藥。如有疑問，請向 家庭醫生（GP）、藥劑師或相關醫護人員查詢。
This form is for organisation only. It cannot tell you whether to take a medicine, how much to take, or when to take it. If unsure, ask a GP, pharmacist or other relevant healthcare professional.
| 藥名Medicine name | 劑量Dose | 何時服用When taken | 由誰開出／購買Prescribed / bought from | 備註Notes |
|---|---|---|---|---|
家中讀數記錄表Home Readings Record
適合記錄體溫、血壓、血氧或其他家中量度數值。Useful for noting temperature, blood pressure, oxygen saturation or other home readings.
讀數只作記錄，不能代替醫護人員判斷。你不應只根據這些數字自行改藥、停藥或延誤求醫。
Readings are for record-keeping only and do not replace professional judgement. Do not change medicines, stop treatment or delay seeking help based on numbers alone.
| 日期／時間Date / time | 體溫Temperature | 血壓Blood pressure | 血氧Oxygen saturation | 其他讀數／備註Other readings / notes |
|---|---|---|---|---|
兒童求診記錄表Child Appointment Record
適合家長在看 家庭醫生（GP）、藥房或 NHS 111 前快速整理兒童情況。Useful for parents before seeing a GP, visiting a pharmacy or contacting NHS 111.
可快速勾選Quick tick boxes
| 觀察項目Observation | 備註Notes |
|---|---|
| 飲水情況Fluids | |
| 食物Food | |
| 尿片／小便／如廁Nappies / urine / toilet | |
| 睡眠／精神Sleep / energy |
陪診者記錄表Carer / Companion Notes
陪伴父母、伴侶或家人求診時，可先整理重要資料與想問的事。Useful when accompanying a parent, partner or family member to an appointment.
| 日常功能／生活情況Daily function / living situation | 記錄Notes |
|---|---|
| 食／飲Eating / drinking | |
| 行動／移動Mobility | |
| 睡眠Sleep | |
| 記憶／情緒Memory / mood | |
| 服藥情況Medicines |
| 我想代為提出的問題Questions I want to ask on their behalf |
|---|
搬到英格蘭前醫療資料整理表Medical Information Before Moving to England
適合在移居前整理重要資料，方便 登記家庭醫生 或第一次求診。Useful for organising key information before moving to England for GP registration or first appointments.
| 項目Item | 內容Details |
|---|---|
| 過往診斷Past diagnoses | |
| 手術／住院Surgery / hospital stays | |
| 過敏Allergies | |
| 長期藥物Long-term medicines | |
| 疫苗紀錄Vaccination history |
| 需要準備的文件Documents to prepare | 已準備？Prepared? |
|---|---|
| 病歷摘要Diagnosis summary | |
| 藥物清單Medication list | |
| 檢查報告副本Copies of reports | |
| 手術／出院文件Surgery / discharge papers | |
| 疫苗紀錄Vaccination record |
| 其他希望提醒 家庭醫生（GP）的重點Other important points to tell a GP |
|---|
抽血預約 清單Blood Test Appointment Checklist
適合在去抽血前手寫確認，避免因沒有 表格 或不知道結果返去哪裡而白行。Use this before a blood test to reduce the chance of missing a form or not knowing where results go.
這張清單只協助你整理行政資料，不判斷你是否需要驗血，也不解讀任何結果。
This checklist only helps organise practical information. It does not decide whether you need a blood test or interpret results.
| 出門前確認Before you go | 已確認？Checked? | 備註Notes |
|---|---|---|
| 這是 NHS 抽血檢查 還是 私家抽血檢查？Is this an NHS or private blood test? | ||
| 申請 是否已電子提交？Has the request been sent electronically? | ||
| 我是否需要帶紙本 抽血檢查表格？Do I need to bring a printed blood test form? | ||
| 手機相片／電郵副本是否接受？Is a phone photo or emailed copy accepted? | ||
| 我有 預約確認／預約編號。I have the appointment confirmation / booking reference. | ||
| 我知道誰會解釋結果及如何追結果。I know who will explain the result and how to chase it. |
一頁醫療摘要One-page Medical Summary
適合第一次見新 家庭醫生（GP）、醫院、私家醫生或陪家人求診時使用。Useful when seeing a new GP, hospital team, private doctor or accompanying a family member.
英格蘭的病歷不一定由所有醫生自動共享。帶一份簡短摘要，通常比帶一大疊舊文件更易溝通。
Records in England are not always automatically shared across all clinicians. A concise summary is often easier to use than a large pile of old documents.
| 項目Item | 內容Details |
|---|---|
| 長期病／重要診斷Long-term conditions / diagnoses | |
| 現有藥物及劑量Current medicines and dose | |
| 藥物／食物過敏Medicine / food allergies | |
| 重要手術／住院Major surgery / hospital stays | |
| 最近檢查／報告Recent tests / reports |
| 今日要處理For today | 內容Details |
|---|---|
| 最困擾的問題Main concern | |
| 何時開始／有否惡化When started / getting worse? | |
| 已試過甚麼What has already been tried? | |
| 我想問的問題 1Question 1 | |
| 我想問的問題 2Question 2 |
| 我會帶同的文件Documents I will bring |
|---|
| 例如：最近 醫院信件、私家報告、出院紙、疫苗紀錄、藥物相片。For example: recent hospital letter, private report, discharge summary, vaccination record, medicine photos. |
重要聲明Important notice
本頁提供的全部內容都只是 空白記錄表格，方便你自行整理資料並帶去求診。它們不會診斷疾病、不會解讀任何讀數，也不會提供醫療建議或治療建議。
英醫路不收集、不儲存、也不查看你填寫在表格上的資料。請你自行保管列印後的文件。如情況危及生命，請立即致電 999；如不確定應求醫方向，請聯絡 NHS 111。
Everything on this page is a blank printable form to help you organise information and bring it to an appointment. These forms do not diagnose illness, interpret readings, or provide medical advice or treatment recommendations.
HealthRoad England does not collect, store or view the information you write on these forms. Please keep printed copies yourself. If the situation is life-threatening, call 999. If you are not sure where to seek help, contact NHS 111.
獨立資訊工具，與 NHS 並無官方關係
