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Hepatitis Progress Monitoring Chart

Track Your Hepatitis Treatment Journey

Gastroenterology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date of Diagnosis: //___ Treating Physician: _________________

Viral Load Tracking

Date Viral Load (IU/mL) Notes

Liver Function Tests

ALT/AST Levels

Date ALT (U/L) AST (U/L) Notes

Medication Adherence Log

Medication Name: _________________ Dosage: _________________

  • Week 1: □ □ □ □ □ □ □
  • Week 2: □ □ □ □ □ □ □
  • Week 3: □ □ □ □ □ □ □
  • Week 4: □ □ □ □ □ □ □

Symptoms Tracker

Rate severity (0-10):

  • Fatigue: ___
  • Nausea: ___
  • Abdominal Pain: ___
  • Joint Pain: ___
  • Other: _______________

Lifestyle Modifications

  • Alcohol Consumption: □ None □ Occasional □ Regular
  • Exercise (minutes/week): ___
  • Hours of Sleep/Night: ___

Next Appointment

Date: //___ Time: : AM/PM

Notes

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