Endometriosis Diary: Pain and Symptom Tracker, Guided Record Book, Daily Discomfort Assessment Journal, Mood, Sleep, Activity, Medication Logbook, Chronic Autoimmune Disease Management Gifts, 6x9

Stressors, Symptoms and Pain overall

Stressors - check one of the available stressors or add your own in the lined space allocated.

Symptoms - check one of the pre-listed symptoms or add to the lined spaces allocated. Options include urinary frequency, painful intercourse, excessive bleeding, severe cramping, fatigue, back/thigh pain, pelvic/bladder pain and more.

Pain location - mark on the image (both front and back are available)

Pain Overall - enter a number ranking, and check one of the pre-listed available or enter your own on the lines available

Medications

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 Assessments & Period/Flow Details

Circle the applicable arrow to specify 'More, Normal, Lower' for Cramping, Period Length, Flow Amount, Clotting'

Circle applicable arrow to indicate 'Increased, Same, Decreased' for Pain, Stress, Fatigue, Energy, Activity, Mental Clarity, Activity L

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, Notes, Meals & Snacks

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

Example of Completed Sections

Daily Assessments - notice that pain and fatigue are increased, energy, activity level and general mood are decreased while stress, mental clarity and sleep quality remain the same/consistent.

Details - cramping and clotting are increased, flow amount remains consistent, and period length is blank as unknown at this point.

Issue Tracker - cramps got really bad at 1pm with a severity of 5 and needed painkiller.

Personal Information & Healthcare Team

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.

Medications and Changes

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.

Tests/Results and Medical Appointments

Upcoming medical appointments - with whom? for what reason, and date

Tests, date performed, and the results.

Additional Logs

Full page

Full page

Test Results and Other Life Change