IBD Symptom Tracking & Progress Chart

Patient Information

Name: ___________________ Date Range: //___ to //___

Daily Symptom Tracker

Rate each symptom from 0-5 (0 = None, 5 = Severe)

Gastrointestinal Symptoms

• Abdominal Pain: □0 □1 □2 □3 □4 □5
• Diarrhea Frequency: ___ times/day
• Blood in Stool: □None □Mild □Moderate □Severe
• Urgency: □0 □1 □2 □3 □4 □5

General Well-being

• Fatigue Level: □0 □1 □2 □3 □4 □5
• Appetite: □Normal □Decreased □Poor
• Sleep Quality: □Good □Fair □Poor

Medication Adherence

Diet Log

• Foods Consumed:
  • Breakfast: ________________
  • Lunch: ____________________
  • Dinner: ___________________
  • Snacks: ___________________

Additional Observations

• Stress Level: □Low □Medium □High
• Exercise: □Yes □No Duration: _____
• Joint Pain: □Yes □No Location: _____

Weekly Summary

• Overall Health Rating: □1 □2 □3 □4 □5 □6 □7 □8 □9 □10
• Days Missed Work/School: ___
• New Symptoms: ____________________

Healthcare Provider Notes

Next Appointment: //___ Notes: _________________________

Bring this chart to all medical appointments