Aspirin (low‑dose) Acetylsalicylic acid Prevention of clotting in cardiovascular disease
If you take any other prescription or OTC medication, please list it below.
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3. Blood Pressure Readings
Please fill out the table for each of your most recent readings:
Date (mm/dd/yyyy) Time (hh:mm am/pm) Systolic (mm Hg) Diastolic (mm Hg)
> Tip: If you have readings from a home cuff, clinic visit, or wearable device, note the date/time so your clinician can review trends.
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4. Optional Additional Data
A. Blood Pressure Medications
If you are on antihypertensive therapy, list each drug (generic name), dose, and frequency:
Medication Dose & Frequency
> Knowing your medication regimen helps the clinician adjust doses or add agents if needed.
B. Lifestyle Factors
These can influence BP and are useful for personalized advice:
Dietary sodium intake (e.g., average grams per day)
Alcohol consumption (drinks/week)
Physical activity (type, duration, frequency)
Sleep quality (hours/night, disturbances)
C. Other Health Information
If you have comorbidities or are on medications that can affect BP (e.g., steroids, stimulants), include them.
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3. How to Submit the Information to Your Doctor
Check your clinic’s preferred method
- Some practices allow email, patient portals, or fax.
- If a portal is available, upload files securely; if not, use a secure email link or fax.
Use a consistent file format
- PDF for documents (e.g., lab results).
- JPG/PNG for images of your glucose monitor screen.
Label each file clearly
- `Glucose_Monitor_Screen_Jan2024.jpg`
- `Lab_Results_Feb2024.pdf`
Add a brief note if needed
Example:
``` Dear Dr. Smith,
Attached are the images of my glucose monitor screen for January 2024, as well as my recent lab results from February 2024. Please let me know if you need any further information.
Thank you, Your Name ```
Send via secure patient portal or encrypted email
If unsure, contact your clinic’s IT support for guidance.
Quick Reference Checklist
Task Done?
Open glucose monitor app ☐
Capture clear screenshots (day/night) ☐
Rename files with date & time ☐
Upload to secure portal / send encrypted email ☐
Verify receipt in patient records ☐
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Stay organized, keep your data secure, and you’ll have a smooth experience for any medical review. Happy tracking!
