You could use CSS to hide all the navigation etc. that you don't need using a media="print"
stylesheet, but you won't be able to make the exact changes to the layout you've illustrated.
If it doesn't have to be exactly like the example, it would be fairly trivial to hide all but the name->value table and just print that. If you really do need to merge fields and re-layout the table then you likely have to hack up the server-side.
Why can't you create your own version of the page?