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Personal Stroke Prevention Monitoring Log

Daily Tracking Sheet for Stroke Risk Management

Cardiology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ___________________ Date Started: //___

Daily Measurements

Blood Pressure Readings

Target BP: /

Time Morning Evening
BP / /
Pulse ____ ____

Medication Adherence

  • Morning medications taken: □ Yes □ No
  • Evening medications taken: □ Yes □ No
  • Blood thinners taken as prescribed: □ Yes □ No

Lifestyle Factors

Physical Activity

  • Minutes of exercise today: _____
  • Type of activity: ________________

Diet Tracking

  • Followed low-sodium diet: □ Yes □ No
  • Servings of fruits/vegetables: _____
  • Glasses of water: _____

Weekly Checks

  • Weight: _____ lbs
  • Blood sugar (if diabetic): _____

Warning Signs (Check if experienced)

□ Sudden numbness/weakness □ Speech difficulties □ Vision problems □ Severe headache □ Balance problems □ Dizziness

Action Taken for Warning Signs

□ Called 911 □ Contacted doctor □ Other: ________________

Notes

Emergency Contacts Doctor: ________________ Phone: _________________

Remember: If you experience stroke symptoms, call 911 immediately.

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