如情況危及生命，請立即致電 999 或前往 A&E（Accident & Emergency，急症室）。
如不確定應去哪裡求助，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。內容只幫助你整理資料，方便和 GP、pharmacist、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 8 款可列印表格，涵蓋症狀、就診問題、覆診跟進、藥物清單、家中讀數、小朋友、陪診者，以及搬到英格蘭前的醫療資料整理。你可先看簡介，再按需要列印個別表格。
There are 8 printable forms below, covering symptoms, appointment questions, follow-up notes, medication lists, home readings, children, accompanying family members, and medical information to prepare before moving to England. Read the summary first, then print only the forms you need.
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
入診症室前，先寫低想問 GP 或 pharmacist 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
記低醫護說明、檢查安排、轉介、覆診時間及回家後要做的事。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、開藥來源及過敏／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. 小朋友求診記錄表6. Child appointment record
適合記低發燒、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
適合陪家人求診時，整理平日狀況、照顧安排及自己想代為發問的重點。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 GP registration 或第一次求診。Organise past diagnoses, surgery, vaccines, allergies, long-term medicines and key reports for GP registration or first appointments.
症狀記錄表Symptom Record Form
適合在看 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.
這張表只幫你整理資料，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? |
|---|---|---|---|---|
GP / Pharmacist 問題清單GP / Pharmacist Question List
把想問的事先寫低，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 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.
| ## | 我想問的問題Question I want to ask | 已答？Answered? |
|---|---|---|
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 |
Appointment 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 GP、pharmacist 或 hospital appointment。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 GP、pharmacist 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 |
|---|---|---|---|---|
小朋友求診記錄表Child Appointment Record
適合家長在看 GP、藥房或 NHS 111 前快速整理小朋友情況。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 GP registration 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 |
| 其他想提醒 GP 的重點Other important points to tell a GP |
|---|
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；如不確定應去哪裡求助，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.
Independent tool — not affiliated with the NHS / 獨立資訊工具，與 NHS 並無官方關係
