Patient Information
Name: _________________________
Date: _________________________
Endocrinologist: ________________
Condition Overview
- Primary diagnosis: ________________
- Secondary conditions: _____________
Medication Schedule
Daily Medications
| Medication |
Dosage |
Time |
Special Instructions |
|
|
|
|
|
|
|
|
Emergency Medications
- Stress dose steroids (if applicable): ______________
- Emergency injection kit location: _________________
Monitoring Plan
Regular Testing Schedule
- Blood tests frequency: _______________
- Hormone level checks: _______________
- MRI/Imaging schedule: ______________
Self-Monitoring
- Daily symptoms to track:
- Fatigue levels
- Headaches
- Visual changes
- Weight fluctuations
Emergency Protocol
Warning Signs
- Severe headache
- Sudden vision changes
- Extreme fatigue
- Signs of hormone deficiency
Emergency Contacts
- Endocrinologist: ________________
- Emergency department: ___________
- Support person: ________________
Lifestyle Management
Activity Guidelines
- Exercise recommendations: _________
- Activity restrictions: ____________
Dietary Considerations
- Sodium intake: _________________
- Fluid requirements: _____________
- Dietary restrictions: ____________
Follow-up Schedule
- Next appointment: _______________
- Regular review frequency: ________
Additional Resources
- Patient support groups
- Educational materials
- Online monitoring tools
Notes