Marshall Results Template by jmullinsMarshall

PATIENT INFORMATION

John Doe

Patient Presentation

Past Medical History Overview

Hypertension

Obesity

Obstructive Sleep Apnea

Diabetes/Pre-Diabetes

Other:

Current Medications & Supplements List

Additional Notes:

(INSERT PATIENT NAME)

(DOB) | (Gender) | (Age) (Member Program)

Lifestyle Inventory

HealthyHabits/AddictiveTendencies Sleep

Family History / Genetics / Epigenetic Inventory

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ASCVD Health Risk Score

89%

Social History Inventory

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Living Situation & Social Support

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Hobbies, Life Goals, Travel Expectations, & Life Expectancy

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Financial Stressors

Sexual History & Reproductive Health

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Preventative Studies Inventory

Breast Cancer Screening

Colon Cancer Screening

Skin Cancer Screening

Cervical Cancer Screening

Prostate Cancer Screening

Obstructive Sleep Apnea Screening

Peripheral Vascular Disease

Electrocardiogram (EKG)

Chest X-Ray

Executive Longevity Health Panel - Biomarkers

Key

Risk Factor Biomarkers

Executive Longevity Health Panel - Biomarkers

Hormone Balance

Testosterone - Total/Free/Bio

Thyroid - TSH/Free T3

Sex Hormone Binding Globulin (SHBG)

Executive Longevity Health Panel - Biomarkers

Organ Health

Kidney Function

Liver Function

Bone Marrow/Blood Counts

Urinalysis

Cancer Detection

Screen

DNA Methylation Patterns -

vs Biologic Age

TruDiagnostic Test

Gut Biome Testing

Functional Metabolites & Pathways

Pathogens & Opportunists

Inflammation & Barrier Integrity

Executive Longevity Health Panel -

Biomarkers

Alzheimer’s Disease Early Detection Performance

P-Tau217

AB42/AB40 Ratio

APOE 4 allele

Body Composition Analysis

SYMMETRY: 14

VISCERIAL FAT

Medical Fitness Assessment

SUMMARY

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HEART CT CALCIUM SCORE RESULTS

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LOW DOSE CT LUNG SCREENING

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WHOLE BODY AND BRAIN MRI

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TREADMILL STRESS TEST

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Advanced Diagnostics Results

NUCLEAR STRESS TEST

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ECHOCARDIOGRAM

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CT ANGIOGRAPHY

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GALLERI EARLY CANCER BIOMETRIC SCREENING RESULTS

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TRUDIAGNOSTIC METHYLATION TESTING

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GUT BIOME TESTING

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FOOD SENSITIVITY TESTING

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GENETIC FITNESS AND NUTRITION TESTING

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SUMMARY OF METRICS & PROBLEMS

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HEALTH AND LIFE GOALS

SUMMARY OF COLLABORATIVE DECISION-MAKING

SUMMARY OF RISK & BENEFITS / RATIONALE FOR TREATMENT

ACTION PLAN WITH MONITORING SCHEDULE

Final Patient Vignette

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Signature

Date/Time