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Implementation
> Monitoring
> Monitoring Protocol
Monitoring Protocol

(It’s a good idea to print this page and have it in front of you when you actually begin working).

1. Does this patient have a Documented Cardiovascular Disease? Y/N.
If so, what is it and what are its’ manifestations?

2. What is this patients status regarding Life-Style Habits?

· Smoking of any amount_______________

· Nutrition ______________

· Physical activity- type and amount ______________

3. In the past 6 months: have BMI, Blood Pressure, Serum Glucose (+HbA1C for Diabetics), Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol and Triglyceride Levels Been Measured?

↓

Yes

No

↓

Request the above measurements and laboratory tests

↓

After data is available - continue

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4. For each of the following risk factors fill in the relevant data:

Risk Factor

Present

Absent

Target
value for this patient

Present value

Satisf. control?

Yes

No

Diabetes Mellitus

    

HBA1C

HBA1C
______%

    

Hypertension

    

Blood Pressure

Blood Press.
____/___

    

Hypercholester. (Elev. Total+LDL Chol.)

 LDL Chol.

LDL Chol.
________

Low HDL Cholesterol

HDL Chol.

HDL Chol.
________
Obesity

BMI

 BMI: _____

Abdominal Obesity

Waist Circumf.

Circ. _____

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5. Is there an indication for therapy with one of the following groups of medications?

 

Yes

No

Is t he patient taking a medication from this group

If the answer is no, is a satisfactory reason given ?

Yes

No

Anti-Thrombotics

 

 

 

 

 

Beta-blockers

 

 

 

 

 

Statins

 

 

 

 

 

Ace- Inhibitor/ ATR antagonists

 

 

 

 

 

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6. Summary of findings and operative conclusions:

  • Begins with a short description of the cardiovascular disease/s and clinical manifestations if present.
  • Continues and describes the patients cardiovascular risk factors, the interventions used for their modification and the degree of modification achieved.
  • Reviews medications.
  • Focuses on cardiovascular risk factors not yet satisfactorily modified.
  • Concludes with on further steps to be taken.