Rate your day overall.
Assess day with arrows to indicate Increased, Same, Decreased for Pain, Fatigue, Stress, Sleep Quality, General Mood, Mental Clarity, Energy Level, Activity Level.
Mood - select from prelisted options.
Physical Therapy and Recommended Exercise - select applicable checkbox
Therapy activities - check activity, list alternate activity and enter time
Notes - for questions, comments, insights
* See completed example further
Activities - select from prelisted options and mark time as desired.
Meals/Snacks - enter and if desired use the checkboxes available to indicate if the meal included protein, vegetable, fruit, dairy, gluten, sugar or fats.
* See completed example
Physical Effects - select from prelisted options that include inflammation, infection, draining, morning stiffness, abdominal or chest pain, bowel/bladder issues, and more.
Pain Description - select from prelisted options.
Pain Location - mark on the provided images where the affected areas are.
Medications - check applicable checkbox to indication 'Usual Daily Medications' and/or 'Usual Daily Supplements'. List additional medications with reason, dose, time and whether it helped.
Incision Changes - use this area to indicate if there are changes in pain severity during the day, and/or the times that you may re-bandage or treat the incision. This provides a record of changes over time.
* See completed example
Today pain and stress are marked as increased.
Fatigue, general mood and activity level are marked as decreased.
Sleep quality, stress and general mood are marked as no change.
Mood is tired and frustrated.
Walked for 20 minutes, did cognitive work for 20 minutes. Added stretching, dexterity and resistance work.
Socialized for 1 hours.
Headache is marked on image, as well as location of abdominal pain/incision location.
Pain is described as tender and incision is pulling.
Took usual daily medications with additional pain medication that helped.
Wound care performed at 9am(discolored discharge) and 9pm. Severity of pain at that time is marked numerically.
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.
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.
Enter tests, when performed and the results.
Foods/drinks/medications to avoid along with the reason and the date for the change.
Upcoming medical appointments - enter with whom, reason/outcome of appointment and the date.
Surgery Recovery Journal | Knee Surgery Recovery Plan | Hip Surgery Recovery Planner | Hip Replacement Healing Record | Post-Surgery Journal | Wrist Surgery Recovery Record | |
---|---|---|---|---|---|---|
Size | 8.5 X 11 inches | 6 X 9 inches | 6 X 9 inches | 6 X 9 inches | 8.5 X 11 inches | 6 X 9 inches |
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