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Second-opinion summary

Second-opinion summary

A one-page summary of the illness, treatment and your questions, with a checklist of the records a specialist will ask for.

Saved only in this browser. Nothing is sent to us.

The patient

Name

Age

Sex

Choose

Female

Male

City

Hospital and unit

Admitted to the ICU on

The illness

Main diagnosis

When it was diagnosed

Other conditions

Why they are in the ICU now

Treatment so far

Current support in the ICU

Tick anything the team has told you is in use.

Ventilator (breathing machine)
Oxygen by mask or nasal tube
Medicines to support blood pressure
Dialysis
Sedation
Feeding tube
Nutrition through a vein (TPN)
Drains

Medicines and allergies

Current medicines

Allergies

Questions for the specialist

Your questions

Family contact

Name

Relationship to the patient

Phone or WhatsApp

Records

Tick what you already have. A specialist will usually ask for all of these.

Medical report or discharge summary
Recent lab results
Scan reports (CT, MRI, ultrasound)
Scan images on CD or USB (DICOM)
Pathology report
Pathology slides and blocks
Operation notes
Chemotherapy or other treatment summary
Medicines list from the ICU
ICU daily notes or charts

Summary language

Second-opinion summary

Fill in the form and your summary will appear here.

Prepared by the family with the Soheir Elmansy Foundation’s free tool. It is not a medical document.

Emergency

In Egypt, call 123 for an ambulance or go to the nearest emergency department. We are not an emergency service and we can’t give medical advice.

Soheir ElmansyFoundation

Contacthello@soheirelmansyfoundation.org

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In memory ofSoheir Elmansyسهير المنسي16 October 2026