Daily Pancreatic Health Tracking Journal

Patient Information

Name: ___________________ Date Started: ___________________ Diagnosis: _______________ Provider: ______________________

Daily Symptom Tracker

Pain Assessment

• Pain Level (0-10): ____
• Location: □ Upper Abdomen □ Back □ Other: ________
• Quality: □ Sharp □ Dull □ Burning □ Cramping
• Duration: _____ hours

Digestive Symptoms

• Nausea: □ None □ Mild □ Moderate □ Severe
• Vomiting: □ Yes □ No | Times per day: ____
• Stool Changes:
  • Color: □ Normal □ Clay-colored □ Dark
  • Consistency: □ Normal □ Loose □ Fatty
  • Frequency: ____ times/day

Dietary Intake

• Meals consumed today: ____
• Fat intake: □ Low □ Moderate □ High
• Alcohol consumption: □ Yes □ No

Medication Log

Additional Observations

• Weight: _____ lbs
• Fatigue level: □ None □ Mild □ Moderate □ Severe
• Other symptoms: ________________________________

Weekly Summary

Glucose Readings (if diabetic): Mon: ____ Tue: ____ Wed: ____ Thu: ____ Fri: ____ Sat: ____ Sun: ____

Notes for Healthcare Provider:

© [Year] [Institution Name] - Gastroenterology Department