| Patient Name: | |
| Symptoms: |
1.________________________________________________________________________
2.________________________________________________________________________
3.________________________________________________________________________ |
| Diagnosis A: | The patient has a dysfunctional _______________________________ (endocrine gland) which is _________________________ (hypo/hypersecreting) the hormone ____________________________ (name). |
| Diagnosis B: | The patient has a dysfunctional _______________________________ (endocrine gland) which is _________________________ (hypo/hypersecreting) the hormone ____________________________ (name). |
| Treatment: | To treat the disorder indicated by diagnosis ______ (A or B) we suggest: |
| Submitted by: |
| Patient Name: | |
| Symptoms: |
1.________________________________________________________________________
2.________________________________________________________________________
3.________________________________________________________________________ |
| Diagnosis A: | The patient has a dysfunctional _______________________________ (endocrine gland) which is _________________________ (hypo/hypersecreting) the hormone ____________________________ (name). |
| Diagnosis B: | The patient has a dysfunctional _______________________________ (endocrine gland) which is _________________________ (hypo/hypersecreting) the hormone ____________________________ (name). |
| Treatment: | To treat the disorder indicated by diagnosis ______ (A or B) we suggest: |
| Submitted by: |