Patient After-Visit Summary (Weight Management Plan)

After-Visit Summary: Weight Management

(Use plain language and direct second person. Avoid medical jargon or abbreviations. Only include items explicitly discussed today—do not add generic advice. Use people-first, non-stigmatizing language.)

Patient: [Patient full name]  |  Date of birth: [DOB]

Visit date: [Visit date]  |  Clinic: [Clinic name]  |  Location: [Clinic address / Telehealth]

Provider: [Provider name, role]  |  Clinic phone: [Clinic phone number]

After-hours: [After-hours contact instructions]

This summary reflects what we discussed today. Bring it to your next visit.

Your Next Steps (Most Important)

(List 3–5 prioritized actions to complete before your next follow-up. For each, state exactly what to do, when/how often, and the start date. Use concrete, measurable language. If an action is conditional, state the condition first. If no new actions, list continuation items.)

1. [Action 1: Specific task, dose/amount or target, timing/frequency, start date]
2. [Action 2: Specific task, dose/amount or target, timing/frequency, start date]
3. [Action 3: Specific task, dose/amount or target, timing/frequency, start date]
4. [Action 4] (Include only if needed)
5. [Action 5] (Include only if needed)

What We Discussed Today

(Provide 3–6 brief bullets covering: patient's stated goals, relevant measurements reviewed, and plan domains addressed such as nutrition, activity, behavior strategies, or medication decisions. Include only items explicitly discussed. Keep patient-facing and simple.)

• [Summary bullet 1]
• [Summary bullet 2]
• [Summary bullet 3]
• [Additional bullets as needed, up to 6 total]

Medicines

(Include this section only if weight-management medicines were started, stopped, changed, continued with new counseling, or discussed as options. Omit entirely if no medication discussion occurred.)

Changes made today:

• [Started/Stopped/Changed: Medication name (brand – generic), brief purpose]
• (Add additional items as needed)

[Medication name (brand – generic)]

• Purpose: [Plain-language purpose, e.g., to help reduce appetite]
• Dose and schedule: [Exact dose], [time of day]; [with / without] food
• Titration schedule: (Include only if applicable)
  1. [Step 1: Dose and duration]
  2. [Step 2: Dose and duration]
  3. (Add steps as needed)
• If you miss a dose: [Clear missed-dose instructions]

Side effects and safety:

• Common or expected: [Effects] — [Self-care tips]
• Call the clinic soon if: [Symptoms prompting a call]
• Get emergency care now if: [Red-flag symptoms]

Special precautions: (Include only if discussed) [Pregnancy/contraception plan, interactions, or other precautions]

(Repeat medication block for each additional medicine as needed.)

(If medicines were discussed but not started, write "Medication options discussed" without dosing details.)

Follow-Up

Recommended follow-up: [Interval or specific date]

Appointment scheduled: [Date, time, location] (Include only if already scheduled)

How to schedule: [Phone number or portal instructions] (Include only if not yet scheduled)

At your next visit, we will review: [Items to reassess, e.g., weight trend, medication effects, lab results, updated goals]

Bring to your next visit: [Requested items, e.g., medication bottles, logs, device readings] (Include only what was requested)

When to Call Us or Get Emergency Care

(Tailor to the plan and any medicines prescribed today.)

Clinic phone: [Clinic phone number]  |  After-hours: [After-hours contact instructions]

Call the clinic soon if you have:

• [Symptoms, side effects, or concerns that should prompt a call]

Get emergency care now (call 911 or go to the ER) if you have:

• [Serious or red-flag symptoms related to today's plan or medicines]

If you feel unsafe or your symptoms are severe, seek urgent care or call 911.