Personal
Prevention Chart
Use this Personal Prevention
Chart to keep track of the preventive care that you
have received and/or will
need in the future. With the help of your health care
provider, fill in how
often you need each type of preventive care. Write in the date
and results of tests each
time you receive preventive care.
Type of Care How Often Goal Dates Results
(Example)
Blood pressure Once a month 130/70 03/03/2004 140/80 _______ _______
Blood pressure __________ _______ _________ _______ _______ _______
Cholesterol __________ _______ _________ _______ ______ _______
Weight __________ _______ _______ _______ _______ _______
Healthy weight for me: __________ Check here
Dental Visits ____________ _______ _______ _______ _______ _______
Vision ____________ _______ _______ _______ _______ _______
Return to
Regular Checkups: Teeth
and Gums, Cholesterol,
Oral
Cancer
Return
to Personal Prevention Charts
Return
to Contents of Staying Healthy at 50+
Table
Of Contents | Introduction
| What
You Can Do To Stay Healthy |
Checkups,
Tests, and Shots You Need To Ask Your Doctor About
Personal
Prevention Charts | More
Information
|