Author Topic: A form for Doctor Appointments  (Read 1413 times)


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A form for Doctor Appointments
« on: August 17, 2010, 02:23:40 PM »
Hey all, I have this great form that I use when I go t evey dctor visit that keeps y bain fog from taking over.  I've just copy/pasted it s you ca copy it to whtever WP program you use.  I also keep a medical history, a list of all drugs that have been tried and the reactions they caused, a list of all doctors I see with phone numbers, fax numbers and addresses.  All of those I print out for new doctors.  This sheet I just update for each appointment.  I add symptoms as they pop up, change meds as needs, adjut allergies as needed, and add questins as I think of them.  I save each date as kind of a medical archive as well.  I hope this helps someone, I couldn't live without it.  Just copy and paste it, then substitue my whining for yours.  LOL

July 11, 2010

Jennifer S
City , ST  Zip

Pharmacy:  Pharmacy
 Phone:  (xxx) xxx-xxxx
Fax:  (xxx) xxx-xxxx

Allergies: Shellfish, NSAIDS, Lexipro, Savella, Ultram, Amitriptyline. Adhesives

Prednisone-  5mg  in the am
Atenelol 50mg- ? tablet in the A.M. - for migraine headaches     
Plaquenil   200 mg twice a day  - TX for AI disease       
Zantac 150mg twice a day- for heartburn
Zyrtec once a day  - for allergies
Flexeril 10mg at Bedtime - for joint stiffness
Trazodone 100mg- one at bedtime
Methotrexate 15mg once a week on Thursdays
Topamax 100mg twice a day for migraine prevention.
Imitrex 100mg for Migraines PRN
Lortab 10/325mg  4 times a day  - for joint pain 
Women?s Multi- Vitamin once a week
Super B complex once a day
Folic Acid 800mcg 2 tablets twice a day

Current Symptoms: Dryness: Increased dryness of eyes, nose,  and mouth.   Not sweating in the heat, just cooking from the inside. Eyes: Some Vision problems, sometimes seems like I?m wearing someone  else?s glasses for about 5 minutes and then my focus comes back.  I?ll get so blurry I?ll have to take off my glasses for a while just to readjust. Some burning, but no grittiness.  Using dry eye drops much more frequently.  Miami trip was way too much. Migraines: Daily migraines started on second day (June 20th) and lasted until the third day after we got back (July 1) And still remain pretty frequent.  About 3 times a week.  Seems to be mostly from exhaustion.  Fatigue is at it?s worst.  Can?t seem to get rested.  New neurological symptoms: hands get pins and needle numbness, like falling asleep.  Strange cold water dripping sensation in hips,  I wipe my face with my hand and it feel like I wiped my face with a shedding cat.  Memory loss, when driving, I can?t remember how I got to where I am. I can?t remember most of Saturday.  Whole days are like a blur.  I?ll got across the house to get something and forget what it was.  I?ll forget what I was going to say mid-sentence.  Typing is horrible.  My mind just goes blank and I just stare off for a while.  Pain: Joint pain in hands is increasing.  Having trouble holding the steering wheel.  Some mild back pain.  Standing or walking for longer then 15-20 minutes at time is very hard on my feet.  Gastrointestinal: stomach pain, severe constipation.

Lortabs 10/325mg-  Totally out as of now.

Heartburn med: went back to zantac, anything else seems to require a preauthorization.  I was able to get Protonix when I was pregnant, but that was with Preauthorization.

Imitrex: I have 4 tablets left, but won?t be eligible for a refill until 7/30, any samples?

No other refills needed until the end of the month:
Plaquenil 7/30
Methotrexate 7/29
Trazadone 8/16

My son tested positives for Strep on July 1,2010.  Would a rapid Strep show if I?m clear of it yet? 

Neurologist Appoint scheduled for July 29,2010.  Should I try to move it up?  Are there test I should have done?

« Last Edit: November 05, 2010, 01:04:55 PM by puccini914 »