Patient Treatment Tracking Chart

Patient Treatment Tracking Chart

Sample Chart

This chart is designed as a 1 page handout, printed front-to back, but it can also be printed as 2 pages. On the front side is a blank chart where you can record dates of blood work, laboratory values, hepatitis C viral load levels, medication dosages, and side effects. You can track these over time, too.

On the back of the chart are instructions explaining how to fill it out, as well as explanations of what the lab tests and medication rows mean.

Bring this chart with you to your provider appointments while you are being treated with medications against hepatitis C.