Cardiovascular Risk Assessment and Management Plan

Patient Information

• Name: ________________________
• Date: _________________________
• Provider: _____________________

Risk Assessment Results

Current Risk Factors

• Hypertension
• Diabetes
• Smoking
• High Cholesterol
• Family History
• Obesity
• Physical Inactivity

Key Measurements

• Blood Pressure: ___/___mmHg
• Total Cholesterol: ___mg/dL
• LDL: ___mg/dL
• HDL: ___mg/dL
• Triglycerides: ___mg/dL
• BMI: ___kg/m²
• A1C (if diabetic): ___%

Management Plan

Lifestyle Modifications

1. Diet Recommendations

   • Reduce sodium intake (<2300mg/day)
   • Increase fruits and vegetables
   • Limit saturated fats
   • Follow DASH diet if hypertensive

2. Physical Activity Goals

   • Target: 150 minutes/week moderate activity
   • Type: ______________________
   • Frequency: _________________

Medication Plan

• Current Medications:

  1. ---

  2. ---

  3. ---

Monitoring Schedule

• BP Check: Every _____ weeks
• Lipid Panel: Every _____ months
• Follow-up Visit: _______________

Risk Reduction Goals

• BP Target: <130/80 mmHg
• LDL Target: <_____mg/dL
• Weight Loss: _____ lbs
• Smoking Cessation Date: _______

Emergency Plan

Seek immediate medical attention if experiencing:

• Chest pain or pressure
• Shortness of breath
• Severe headache
• Dizziness or fainting

Patient Signature

Provider Signature