Functional Medicine Lab Review Report

Document Type: Functional Medicine Lab Review Report

Patient: [Patient name], [DOB], [MRN]

Author: [Clinician name], [Credentials]

Date Authored: [Date and time]

Encounter: [Date of service / Asynchronous chart review performed on date]

Labs Reviewed From: [Source(s): EHR / outside PDFs / patient-provided results / specialty lab portal]

Note: This report interprets results; it does not replace the original laboratory report.

Reason for Report

[Clinical indication and question(s) being addressed] (If indication is unknown, state: "Reason for testing not provided in available records.")

• [Primary clinical concern or goal]
• [Secondary concern or relevant comorbidity] (Include only if applicable)
• [Panels/tests reviewed with collection dates and specimen types]

Clinical Context

(Include only details that influence interpretation. If unavailable, state: "Clinical context unavailable; interpretation is limited accordingly.")

• Active diagnoses relevant to labs: [Pertinent diagnoses or conditions]
• Pertinent symptoms: [Key symptoms with timing and trajectory]
• Current medications and supplements: [Items affecting lab interpretation: hormones, high-dose vitamins, binders, antibiotics, steroids, anticoagulants, etc.]
• Pre-analytic conditions: [Fasting status, time of draw, cycle day for hormone testing, specimen handling notes]

Results

(Enter verified values from reports. Use lab-provided units and reference intervals exactly as provided. Note pending or unavailable results explicitly.)

Conventional Labs

(Group by panel or physiologic domain: cardiometabolic, thyroid, hematology/iron, renal, hepatic, inflammation.)

Analyte	Result	Units	Reference Interval	Flag	Collection Date	Performing Lab
[Test name]	[Value]	[Units]	[Reference range]	[H / L / Critical / —]	[Date]	[Lab name]

Specialty Labs

(Stool markers, urinary metabolites, micronutrient panels, hormone panels, genomics. Preserve lab-specific reference intervals.)

Marker	Result	Units	Reference Interval	Flag	Collection Date	Performing Lab
[Marker name]	[Value]	[Units]	[Reference range]	[H / L / Critical / —]	[Date]	[Lab name]

Trends

(Include when ≥2 timepoints available for clinically relevant markers. Otherwise omit this subsection.)

Analyte/Marker	Prior Result (Date)	Current Result (Date)	Units	Δ from Prior	% Change
[Test name]	[Value] ([Date])	[Value] ([Date])	[Units]	[Absolute delta]	[Percent change]

Data Quality Notes: [Specimen or processing issues, missing reference ranges, tests with no results: "Result pending / not available"] (Omit if no issues)

Key Findings

• Critical or time-sensitive findings: [Critical values and action taken or escalation plan] (Include only if present)
• [Most clinically significant abnormality with context]
• [Additional significant abnormality with trend or magnitude]
• [Notable pattern or discordance affecting risk assessment]
• [Key relevant negatives that alter management] (Include only when they change clinical decision-making)

Interpretation and Assessment

(Organize by clinical problem, highest risk first. Distinguish between established diagnoses, risk states, and hypotheses. For specialty markers with proprietary reference intervals, note: "Interpretation relies on lab-provided reference intervals; clinical utility may vary.")

[Problem title reflecting dominant pattern or condition]

What is abnormal: [Markers abnormal and degree of deviation]

Clinical significance: [Why it matters; associated risks or outcomes]

Differential considerations: [Physiologic/benign causes, medication/supplement effects, pre-analytic artifacts, pathologic causes]

Additional information needed: [Confirmatory data or context to discriminate between possibilities]

[Next problem title]

(Repeat structure for each additional problem)

What is abnormal: [Details]

Clinical significance: [Details]

Differential considerations: [Details]

Additional information needed: [Details]

Recommendations and Plan

(Organize by problem. Provide actionable steps with specific timelines, doses, and durations.)

[Problem title]

• Diagnostic next steps: [Confirmatory labs, imaging, questionnaires, trials off interfering agents with timing of re-test]
• Therapeutic recommendations: [Lifestyle interventions with specifics; supplements with dose, duration, monitoring, contraindications; medications if within scope]
• Referrals: [PCP / specialist / dietitian with rationale] (Include only if indicated)

[Next problem title]

(Repeat structure for each problem)

• Diagnostic next steps: [Details]
• Therapeutic recommendations: [Details]
• Referrals: [Details]

Monitoring Plan

(Define who will order, track, and communicate results. Include targets and triggers for earlier action.)

Problem/Marker	What to Monitor	Timing	Target/Goal	Triggers for Earlier Action	Responsible Party	Follow-up Modality
[Problem or marker]	[Specific labs and/or symptom metrics]	[Interval]	[Evidence-based target]	[Symptoms or thresholds prompting earlier contact]	[Clinician/team member]	[In-person / video / portal / phone]

Urgent guidance: [Specific symptoms requiring immediate clinic contact or emergency care] (Include only if applicable)

Critical Results Communication

(Include only if critical or urgent results are present. Otherwise omit entire section.)

• Date/time result became known: [Date and time]
• Person notified: [Name and role]
• Method of notification: [Phone / portal / in-person]
• Confirmation received: [Yes / No with details]
• Action taken: [Immediate management steps]

Limitations

(Document material limitations affecting interpretation. Omit section if none.)

• [Missing data and impact on interpretation]
• [Patient-reported information not independently verified]
• [Assumptions made and effect on certainty]
• [Discordance between specialty and conventional markers requiring confirmatory testing]