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Cardiovascular Risk Assessment Progress Tracker

Patient Monitoring and Risk Factor Management Tool

Cardiology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date of Birth: _________________ Chart Number: __________ Primary Care Provider: ___________

Risk Factor Monitoring

Blood Pressure Readings

Date Systolic Diastolic Notes

Lipid Profile

Parameter Target Date/Result Date/Result Date/Result
Total Cholesterol <200 mg/dL
LDL <100 mg/dL
HDL >40 mg/dL
Triglycerides <150 mg/dL

Additional Risk Factors

  • Smoking Status: □ Never □ Former □ Current
  • Family History of CVD
  • Diabetes Status
  • Physical Activity Level
  • BMI: ______

Risk Score Calculation

Framingham Risk Score

Date Score 10-Year Risk Notes

Intervention Tracking

Medications

Medication Dose Start Date Changes

Lifestyle Modifications

  • Diet Changes:
  • Exercise Plan:
  • Stress Management:

Goals and Progress

Short-term Goals (3-6 months)

  1. BP Target: _______________
  2. Cholesterol Target: _______
  3. Weight Target: ___________

Long-term Goals

Follow-up Schedule

Next Appointment: _______________ Next Lab Work: ________________

Provider Signature: _____________ Date: _____________

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