Pulmonary Fibrosis Journal: Track Symptoms, Establish Patterns and Mitigate Effects with Large Print Daily Record

Triggers, Symptoms & Pain Location

Triggers - check one of the available triggers.

Images to mark location of pain/symptoms

Notes - for additional information, questions, insights Symptoms - check one of the pre-listed symptoms (options include chest pain, clubbed nails, breathlessness, vertigo, fatigue, cough/phlegm, wheezing, sweating/chills, irregular heartrate, skin color changes, headache, memory loss, tender lymph nodes, and more).

Medications

Medications - there is a checkbox to indicate 'Usual daily medications' and to indicate 'Usual daily supplements'.

Additional medications can be listed along with reason, dose, time and whether it helped.

Daily Assessments, Mood, Oxygen level, Activities

Rate your day overall.

O2 Level

Weight, Air Quality, Allergen Levels

Mood - select from listed options

Daily Assessments - circle the applicable arrow to indicate 'Increased, Same, Decreased' for Pain Level, Stress Level, Energy Level, Strength Level, Mental Clarity, Activity Level, General Mood, Sleep Quality

Activities - select from pre-listed options and add time spent at that activity.

*Scroll further to see sample completed sections.

Additional Activities, Meals & Snacks

Activities - list additional activities along with time and how you felt

Meals & Snacks - List and use available checkbox to indicate if the meal included dairy, gluten, sugar or fats.

Hydration

Complete assessments and activities

Sample page

Personal Information and Healthcare Team

Introductory page has space for personal info including allergies and medical alerts.

Enter doctor and contact info.

Enter pharmacy and contact info.

Enter insurance information.

Medications & Supplements, and Changes to Medications/Supplements

Additional Logs

Tests/Results and Day Summary

Day Summary also allows for trends of O2 levels and how you felt each day.

Right Page

Left Page