Print out this table and use it to make notes to take to your doctor.
Put a check mark beside the symptoms you have. Note when you have them.
Symptom | Where? | When did you first notice? | How often? | Recent dates? | |
---|---|---|---|---|---|
Example: rash | face and chest | 2 years ago | Once or twice a month | 9/17, 10/8, 10/23, 11/15 | |
Red rash or color change | |||||
Painful or swollen joints | |||||
Fever with no known cause | |||||
Feeling very tired | |||||
Trouble thinking, memory problems, confusion | |||||
Chest pain with deep breathing | |||||
Sensitivity to sun | |||||
Unusual hair loss | |||||
Pale or purple fingers or toes | |||||
Sores in mouth or nose | |||||
Other |
Adapted from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).