Triggers - options include heat, trauma, dehydration, salt, stretching, prolonged standing/sitting, lack of compression and more
Pain description
Symptoms - options include bruising, fatigue, bladder/bowel, heart rate, temperature issues, and more
Daily Assessments - Circle applicable arrow to indicate 'Increased, Same, Decreased' for Pain, Stress, Fatigue, Energy, Activity, Mental Clarity, Activity Level, General Mood, Sleep Quality
Blood pressure - space allocated to enter BP and time (2x)
Heart rate - space allocated to enter pulse and time (2x)
Sleep - enter hours
Gastrointestinal issues - easy to circle up, down, steady for reflux, bloating, diarrhea, constipation, nausea
Exercise - check box for Recommended Exercises. List exercises along with time and how felt.
Activities - select from prelisted options (exercise, self-care, socializing, hobbies, employment, house/yard work, childcare, commute) and enter time. Check box to indicate if pacing was good.
Notes - insights, comments, questions, additional information
Meals & Snacks - list and check applicable box to indicate if meal contained salt, meat, dairy, gluten, sugar, fats
Symptom Note - for symptom details.
Medications - check box to indicate 'Usual Daily Medications' and/or 'Usual Daily Supplements'.
List additional medications with reason, time, dose and whether it helped.
Daily Assessment - note that pain and fatigue are increased while energy, activity and general mood are all decreased. There is no change for stress, mental clarity or sleep quality.
Vertigo is up, bloating is down, vision and anxiety are the same, and running a temperature.
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.
Ehlers Danlos Symptom Tracker | Ehlers Danlos Logbook | Gastroparesis Journal | Blood Pressure, Heartrate, Oxygen Logbook | Fibromyalgia Logbook | POTS Journal | |
---|---|---|---|---|---|---|
Size | 6 X 9 inches | 6 X 9 inches | 6 X 9 inches | 6 X 9 inches | 6 X 9 inches | 6 X 9 inches |
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