FLOW SHEET Heart Failure Care Provider
Patient
Title:
Dr.
Name :
Patient Test
Physician:
Zuchelkowski, Jan
Chart Number :
9538
Clinic:
Millway Medical Centre Inc.
D.O.B :
March 8, 1988
Diagnosis Assessment Date
Description
Onset Date
No Data To Display
MEDICAL HISTORY
Problem List
Medications No Data To Display
No Data To Display
Provider
Patient
Title:
Dr.
Name :
Patient Test
Physician:
Zuchelkowski, Jan
Chart Number :
9538
Clinic:
Millway Medical Centre Inc.
D.O.B :
March 8, 1988
VISITATION Procedure
Target
SODIUM POTASSIUM CREATININE eGFR Weight HF Symptoms - Fatigue HF Symptoms Dizziness HF Symptoms - Dyspnea on Exertion HF Symptoms - Dyspnea at Rest HF Symptoms Orthopnea HF Symptoms Paroxysmal Nocturnal Dyspnea HF Symptoms - Dyspnea HF Symptoms - Cough NYHA Functional Capacity Classification Blood Pressure Heart Rate JVP Elevation Pitting Edema Pitting Edema: Location Lung Crackles and/or Wheezing Lung Crackles and/or Wheezing: Location ER Visits for HF Since Last Assessment Education - Medication Use Education - Salt/Fluid Vigilance Education - Daily Weight Monitoring Education Exercise/Activity HF/CAD Risk Factors: Hypertension HF/CAD Risk Factors: Smoking HF/CAD Risk Factors: Diabetes
0-89 60-500
Patient Target
Base Line
24-April-2012
HF/CAD Risk Factors: Overweight HF/CAD Risk Factors: Hyperlipidemia Collaborative Goal Setting Self Management Challenges Condider ASA Use Medication Management
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