Enviar Registros Médicos
Envíe sus registros médicos para evaluación médica
El primer paso es enviar los registros médicos relevantes para que nuestro equipo médico pueda revisar su historial. Complete el formulario a continuación con un resumen de su caso, y un coordinador de pacientes le seguirá para recoger sus registros de forma segura y guiarlo en los siguientes pasos.
Medical records checklist
Gather these items before you begin. Having everything ready helps our medical team review your case quickly and accurately.
Required Helpful if available
Patient identification
Required- Full legal name & date of birthOf the patient receiving evaluation.
- Photo ID / passport copyFor international coordination if traveling.
- Primary caregiver contactName and relationship of the person managing care.
Diagnosis documentation
Required- Official diagnosis letterFrom your neurologist or treating physician.
- Specialist consultation reportsNotes from neurologists, psychiatrists, or rehab specialists.
- Onset & progression timelineWhen symptoms began and how they have changed.
Imaging & test results
Optional- MRI or CT scansMost recent brain imaging, with the radiologist's report.
- PET or DAT scansIf available, for Parkinson's or cognitive evaluations.
- EEG or nerve conduction studiesIf relevant to the condition.
Medications & allergies
Required- Current medication listNames, dosages, and frequency of all medications.
- Past treatments triedMedications or therapies attempted and their outcomes.
- Allergies & sensitivitiesKnown drug allergies or adverse reactions.
Medical history
Optional- Relevant lab resultsBlood work, genetic tests, or biomarker panels.
- Prior surgeries & hospitalizationsDates and outcomes of major procedures.
- Family medical historyNeurological or hereditary conditions in the family.
Functional & cognitive status
Optional- Cognitive or neuropsychological assessmentsMMSE, MoCA, or similar scores if completed.
- Mobility & daily living notesCurrent independence level and assistive devices.
- Therapy historyPhysical, occupational, or speech therapy received.
Contact & pathway preference
Required- Email & phone numberWhere a coordinator can reach you securely.
- Preferred pathwayTravel to Cuba for in-person care, or remote telemedicine follow-up.
- Questions for the medical teamAny concerns you want the specialists to address.
El envío de registros no garantiza evaluación ni tratamiento. La elegibilidad depende de la valoración médica, y las posibilidades de tratamiento las determina el equipo médico. Este formulario recoge un resumen de su caso; un coordinador le guiará sobre cómo compartir sus registros completos de forma segura.