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Gallbladder Disease Symptom and Progress Tracking Chart

Patient Self-Monitoring Tool for Gallbladder Conditions

Gastroenterology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________
Date Range: _____________ to _____________

Daily Symptom Tracker

Pain Scale (0-10)

Date Morning Afternoon Evening After Meals

Symptoms Checklist

  • Right upper abdominal pain
  • Nausea
  • Vomiting
  • Fever
  • Bloating
  • Indigestion

Dietary Triggers

Food Intake Log

Date Meal Foods Consumed Symptoms (Y/N) Severity (1-5)

Medication Record

Date Medication Dose Time Taken Effects

Notes for Healthcare Provider

Unusual symptoms or concerns: ________________________________

Emergency Warning Signs

  • Severe abdominal pain lasting >4 hours
  • Fever >101°F (38.3°C)
  • Yellowing of skin/eyes
  • Persistent vomiting

Contact your healthcare provider immediately if you experience any warning signs

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