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Fungal Skin Infection Monitoring Chart

Patient Progress Tracking Tool

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________________ Chart Number: _________________ Start Date: ____________________

Daily Monitoring Log

Symptoms Tracking (Rate 0-3: 0=None, 1=Mild, 2=Moderate, 3=Severe)

Date Itching Redness Scaling Treatment Applied Notes

Affected Area Measurement

Size of Affected Area (cm)

  • Initial Size: ____________
  • Week 1: ________________
  • Week 2: ________________
  • Week 3: ________________

Treatment Adherence

Daily Medication Log

  • Morning Application: ☐
  • Evening Application: ☐

Important Reminders

  • Keep affected area clean and dry
  • Apply medication as prescribed
  • Take photos weekly if possible
  • Contact doctor if symptoms worsen

Follow-up Appointments

Next Visit: _________________ Provider: __________________

For Clinical Use Treatment Plan: ____________ Prescribed Medication: _____

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