Track Your Pituitary Health Progress
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Name: _______________________ Date of Birth: //______ Chart Number: ________________
| Date | Level (ng/mL) | Reference Range | Notes |
|---|---|---|---|
| 2.1-17.7 (M) | |||
| 2.8-29.2 (F) |
| Date | Level (ng/mL) | Reference Range | Notes |
|---|---|---|---|
| <1.0 |
| Date | Level (ng/mL) | Age-Specific Range | Notes |
|---|---|---|---|
Frequency (per week): _____ Intensity (1-10): _____
| Medication | Dose | Start Date | End Date | Response |
|---|---|---|---|---|
| Date | Size (mm) | Change from Previous |
|---|---|---|
| Date | Provider | Key Discussion Points |
|---|---|---|
Please bring this chart to all endocrinology appointments
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