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Peripheral Arterial Disease (PAD) Progress Tracking Chart

Monitor and Record Your PAD Management Journey

Cardiology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: ___________ Provider: ______________

Monthly Symptom Tracker

Walking Distance Before Pain (Claudication Distance)

Date Distance (blocks/meters) Pain Level (0-10) Notes

Ankle-Brachial Index (ABI) Measurements

Date Right Leg Left Leg Provider Initials

Lifestyle Modifications Tracker

Exercise Program

  • Minutes walked per day: _______
  • Days per week: _______
  • Type of exercise: _______

Smoking Cessation (if applicable)

  • Quit date: _______
  • Days smoke-free: _______
  • Support resources used: _______

Blood Pressure Readings

Date Morning Evening Medications Taken

Medication Log

Medication Name Dosage Time Taken Side Effects

Goals and Progress Notes

  1. Short-term goals:

  2. Long-term goals:

Emergency Contact Information

Provider: _________________ Phone: ____________________ Emergency Contact: ________ Phone: ____________________

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