Triggers - options include environmental exposure, weather/temperature, overwork, infection, medications and more.
Symptoms - include skin sensitivity, painful joints, tissue loss/ulcers, swollen/painful joints, rash, heartrate, breathlessness, fever, scaled skin, discolored skin, gastrointestinal, hair loss, thickened skin, and more.
Pain description - options include numbness, tingling, pulling, hives, itching, swelling and more.
Pain location on images
Medications - check box to indicate 'Usual Daily Medications' and/or 'Usual Daily Supplements'.
List additional medications with reason, time, dose and whether it helped.
Circle applicable arrow to indicate 'Increased, Same, Decreased' for Pain, Stress, Fatigue, Energy, Activity, Mental Clarity, Activity Level, General Mood, Sleep Quality
Enter - Blood Pressure, Heartrate, Oxygen level
Sleep hours - both night and day
Mood - select from prelisted options
Issue Tracker - when weakness, pain or discomfort comes sporadically during the day you can enter the symptom here along with when it happened/how long it happened, and rate the severity by circling a number.
Activities - select from prelisted options (walking, self-care, socializing, hobbies, employment, house/yard work, childcare, commute) and enter time. Check box to indicate if you were able to exercise.
Notes - insights, comments, questions, additional activities
Meals & Snacks - list and check applicable box to indicate if meal contained salt, red meat, dairy, gluten, sugar, fats
Daily Assessments - note that pain, stress are increased, energy and mental clarity are decreased while fatigue, activity, general mood and sleep quality are the same or consistent.
Issue Tracker - note that there was an episode of vomiting after lunch with a severity of 5. There were also palpitations at 7pm with a severity of 3.
Introductory page has space for personal info including emergency contact, allergies, medical alerts and health conditions.
Enter name, address, phone # for physician, specialists, pharmacy as well as insurance information.
Page for current medications / supplements along with reason and refill due date.
Page for CHANGES to medications and supplements with reason for the change, new dose, and date effective.
Upcoming medical appointments - with whom? for what reason, and date
Tests, date performed, and the results.
Raynaud's Syndrome Tracker | Sjogren's Journal | Lupus Tracker | Scleroderma Logbook | Dermatomyositis Journal | Dermatomyositis Record Book | |
---|---|---|---|---|---|---|
Size | 6 X 9 inches | 6 X 9 inches | 8.5 X 11 inches | 6 X 9 inches | 6 X 9 inches | 6 X 9 inches |
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