Medical

binder
 VISITS to the Doctor
Date Doctor Reason Result Follow up
 MEDICATION log
FOR:
MEDICATION:
DOSAGE:
RX:
ADDITIONAL INFO:

Date Time Taken (x) Date Time Taken (x)

 BLOOD SUGAR tracker
Meals 1 hr 2 hr 3 hr
Sunday

B:
L:
D:
Notes:
B:
Monday

L:
D:
Notes:
B:
Thursday Wednesday Tuesday

L:
D:
Notes:
B:
L:
D:
Notes:
B:
L:
D:
Notes:
B:
Friday

L:
D:
Notes:
B:
Saturday

L:
D:
Notes:
 SYMPTOMS tracker
Date Duration Food/Medicine/Activity Symptoms
 DENTAL log
Date Dentist Treatment Follow Up
 MEDICAL Contacts
Specialty Specialty
Name Name
Phone Phone
Address Address

Specialty Specialty
Name Name
Phone Phone
Address Address

Specialty Specialty
Name Name
Phone Phone
Address Address

Speciality Speciality
Name Name
Phone Phone
Address Address

Speciality Speciality
Name Name
Phone Phone
Address Address
 GROWTH tracker
CHILDS NAME:
DATE OF BIRTH:
WEIGHT AT BIRTH:
HEIGHT AT BIRTH:

Date Age Weight Height Notes

BLOOD PRESSURE log
Date Time AM/PM Blood Pressure Pulse Notes

AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
AM/PM
Medical Info
name:
3-INCH SPINES
4-INCH SPINE
 1-INCH SPINES

1 1/2-INCH SPINES
2-INCH SPINES
BODY MEASUREMENTS chart
Date Weight +/- Notes
 GROCERY list
week of:

Produce Dairy EXP Meat EXP

Condiments Drinks EXP MiscellaneousEXP

Canned Goods Frozen EXP Baking EXP

 RECIPES to try
Recipe Cookbook/Source Page #
 WATER tracker
8 glasses a day challenge

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday
 GOALS & REWARDS
Weight Reward Pounds Lost Date
Transformation: BEFORE
FRONT SIDE

BACK STATS

Weight
Body Fat (%)
BMI
Hips
Waist
Chest
Arms
Thighs
Cholesterol
Transformation: AFTER
FRONT SIDE

BACK STATS

Weight
Body Fat (%)
BMI
Hips
Waist
Chest
Arms
Thighs
Cholesterol
RECIPE
SERVINGS: PREP TIME:

Ingredients Directions
 DAILY inspiration
~ Good, better, best. Never let it rest. 'Til your good is better
and your better is best.
St. Jerome

~ The way to get started is to quit talking and begin doing.

Walt Disney

~ In order to succeed, we must rst believe that we can.

Unknown

~ Life is 10% what happens to you and 90% how you react
to it.
Charles R. Swindoll

~ What you do today can improve all your tomorrows.

Ralph Marston

~ You are never too old to set another goal or to dream a

new dream.
C. S. Lewis

~ You can't cross the sea merely by standing and staring at

the water.
Rabindranath Tagore
DAILY inspiration
 JOURNAL
date:
 MEDICAL CONSULTATION log
date:
Name:
Medication:

Dose/Directions:

Date Started/Ended:

Purpose:

Prescribed by Dr. :

Notes & Comments

Medical binder
for children
CHILDnotes
 MEDICAL CONSULTATION log
date:
Name:
Medication:

Dose/Directions:

Date Started/Ended:

Purpose:

Prescribed by Dr. :

Notes & Comments

 DOCTOR visit

Name:
Name:
Age:
Medication:

Height:
Weight:
Purpose of Visit:

Symptoms:
Duration:
Pain:
Purpose: 1 2 3 4 5 Yes: No:
Changes in:

Current Medication:

Other notes:
 VITAL information

Name:
Date of birth:
Weight:
Height:
Blood type:
Primary Dr. Name:
Primary Dr. Phone #:
Dr. Address:
Dentist Name:
Dentist Phone #:
Dentist Address:
Insurance Name:
Insurance Policy #:
Insurance Phone #:
 FAMILY history
Name:
Date Medical Procedure

Date Allergies

Date Medicines

Notes & Concerns

 Date:
MEDICAL release
Parent/Legal Guardian Name:
Address:
E-mail:
Phone #s:
Cell #:
Work #:
Home #:
Other #:
Medical Procedure, Allergies, Medicines and
Childrens Name
other drugs taken regularly

In an emergency, please contact:

Phone #s:
Relationship to child/children:
Or contact:
Phone #s:
Relationship to child/children:

Physicians Name:
Phone #s:
Address:

Signature: