The Patient Passport

• Patient informationName, date of birth, and the date you last updated the sheet.
• 1. Official diagnosesGrouped by system: autonomic and cardiac; connective tissue and joint; pain and neurological; gastrointestinal; pulmonary and sleep; gynecological and hormonal; hematology and immune. For each, who diagnosed it and when.
• 2. Ongoing active strugglesWhat is still happening now: autonomic and positional symptoms, pain and joint dynamics, GI and mucosal issues, sleep and energy.
• 3. History and clinical timelineMajor health notes, the onset of chronic symptoms, every specialist evaluation, and every test, in date order. As a medical journey goes on it becomes hard to remember what happened when. Document it. The sheet uses a color key: red for procedures and results, yellow for injuries, green for medications, purple for diet and supplements, blue for vitals and measurements.
• 4. Care team and specialistsEvery doctor with their clinic network and phone number: pediatrician or primary care, gastroenterology, rheumatology, neurology, pulmonology and sleep, gynecology, psychiatry, integrative medicine, cardiology, adolescent medicine.
• 5. Next steps and immediate care planYour to-do list, so that neither you nor your caregiver forgets an action item, like a sleep study trial or a lab and supplement review.

• Hand Part 1, the Health History Briefing Sheet, to the nurse or doctor at intake.
• Open your symptom tracker, app, or printout to show documented patterns.
• Re-read the doctor scripts so the words are fresh.
• Have a pen ready for the right-hand column.

• Primary symptom"My dizziness and heart rate spike every time I stand up. What physical testing can we order to evaluate this?"
• Lab work or diagnostics"My fatigue has gotten worse over the past month. Can we check my ferritin (iron stores) and inflammatory markers today?"
• Treatment or medication"Before starting a new medication, what specific root cause are we attempting to treat, and what are the potential side effects?"
• Differential diagnosis"If we look beyond stress or anxiety, what other physical conditions are on our differential diagnosis list today?"
• Referral request"Given the severity of my joint cracking and pain, can you place a referral to a rheumatologist or dysautonomia clinic?"

For when the doctor hesitates, dismisses a concern, or declines a test or referral. Say the line, then write down their stated reason or agreed next step.

If a test or referral is declined:

Could you please document your specific clinical justification for declining this test in my medical record?

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If symptoms are attributed to "anxiety" or "stress":

I understand anxiety affects health, but these physical symptoms occur regardless of my stress level. What physical causes can we rule out first?

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The end-of-visit summary has 4 lines. Fill them in before you stand up:

• Tests ordered today, for example CBC, iron panel, tilt-table, MRI.
• Prescriptions or modifications, for example a dosage change or a new supplement protocol.
• Referrals placed, for example cardiology or gastroenterology.
• Follow-up appointment, for example return in 4 weeks, or after the lab results come in.