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<div class="HwContainer HwElement" id="HwContainer"><a class="HwMainSkipNavigation" href="#HwContentTitle"><span class="HwAccessibilityText">Skip Navigation</span></a><div class="HwBlock" id="HwMain" role="main"><div class="HwRow"><div class="HwColumn" id="HwColumnSidebar1"><div class="HwCustom" id="HwCustomSidebar"> </div></div><div class="HwColumn" id="HwColumnContent"><div id="HwContentTop"> </div><div class="HwTypeSpecial HwContentWrapper HwElement" role="article" id="HwContentWrapper"><div class="HwCustom" id="HwCustomContentTop"> </div><div class="HwContentHeader"><p><a name="top" id="Hwtop"><span class="HwAccessibilityText">Top of the page</span></a> </p></div><div class="HwContentTitle"><h1 id="HwContentTitle" tabindex="-1">Health Tracking Forms and Checklists</h1></div><div class="HwContentTopNavigation"> </div><div class="HwContent"><div class="HwNavigationSection HwSectionSpecialSection" id="sec-bs1006"><h2 class="HwSectionTitle" fingerprint="5bf8825f" fingerprint-exact="c7a5655a">Get Started</h2> <figure class="HwMedicalImage HwMedicalImageWrapper hw-medical-figure HwMedicalImageOptional" data-hw-width="460"><img data-hw-resource-path="media/medical/hw/acf6395_300x196.jpg" alt="Photo close-up of a pen being used to fill out a form" data-hw-height="300" data-hw-width="460" src="https://ixbapi.healthwise.net/Resource/14.6/en-us/media/medical/hw/acf6395_300x196.jpg" hw:resource-path="media/medical/hw/acf6395_300x196.jpg" hw:release-quarter="14.6"></figure> <p fingerprint="6d8dc474" fingerprint-exact="184b056f">This page contains printable checklists, diaries, charts, plans, and self-tests to help you keep track of your health. Use the sleep diary to find out more about what affects your sleep patterns. Print off a form that can help you monitor your blood sugar. Take a quiz to get a better idea of how well you cope with stress. Or print the menu plan and grocery list and post it on your refrigerator to help you make better food choices.</p> <p fingerprint="e651aaad" fingerprint-exact="4e9f5f92">To get started tracking your health, click on a form below.</p> <h3 class="HwSubSectionTitle" fingerprint="1587dbf5" fingerprint-exact="b0839b3f">Checklists</h3> <ul fingerprint="016f5e50" fingerprint-exact="cb26a168"> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa114499.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa114499.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa114499.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Evaluating Hospice Programs </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_av2494.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_av2494.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_av2494.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Preventing Falls at Home </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_ug1255.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_ug1255.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_ug1255.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Vertigo: Checklist for the Home </span></a> <span class="NoWebPrint"> </span> </li> </ul> <h3 class="HwSubSectionTitle" fingerprint="49e6e8ae" fingerprint-exact="4cf3967e">Diaries, Charts, and Records</h3> <ul fingerprint="619f29ea" fingerprint-exact="65093a3b"> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tj2602.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tj2602.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tj2602.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Alcohol Use: Identifying Reasons to Cut Down On or Stop </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_ug2542.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_ug2542.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_ug2542.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Asthma Diary </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tb1868.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tb1868.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tb1868.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Blood Pressure: Home Log </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_ug3271.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_ug3271.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_ug3271.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Childhood Immunization Record </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_ug1344.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_ug1344.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_ug1344.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Cirrhosis: Sodium Record </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa15771.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa15771.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa15771.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Diabetes: Tracking My Feelings </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tb1867.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tb1867.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tb1867.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Diabetes: Home Blood Sugar Diary </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa21125.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa21125.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa21125.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Diabetes in Adults: Record of My High Blood Sugar Emergency </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa20801.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa20801.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa20801.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Diabetes in Adults: Record of My Low Blood Sugar Problems </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_uq2705.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_uq2705.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_uq2705.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Diabetes in Children: Record of My Child's High or Low Blood Sugar Problems </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa164142.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa164142.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa164142.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Headache Diary </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa129142.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa129142.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa129142.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Healthy Eating: Tracking My Servings From Each Food Group </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tw9636.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tw9636.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tw9636.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Heartburn Symptom Record </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa86936.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa86936.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa86936.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Heart Failure: Track Your Weight, Food, and Sodium </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa86932.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa86932.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa86932.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Heart Failure: Symptom Record </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa137606.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa137606.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa137606.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Incontinence: Voiding Log (Bladder Record) </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa151402.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa151402.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa151402.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Menstrual Diary to Monitor Premenstrual Symptoms </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_abg7017.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_abg7017.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_abg7017.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Pain Diary </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zx3021.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zx3021.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zx3021.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Physical Activity Log </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_uh1814.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_uh1814.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_uh1814.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Record of My Medicines and How Well They Work </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tm4434.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tm4434.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tm4434.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Sleep Journal </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tm6566.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tm6566.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tm6566.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Symptom Diary </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zx3020.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zx3020.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zx3020.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Women's Fertility: Charting My Basal Body Temperature (Fahrenheit) </span></a> <span class="NoWebPrint"> </span> </li> </ul> <h3 class="HwSubSectionTitle" fingerprint="47596f8c" fingerprint-exact="cddbbbf4">Making the Most of Your Appointments</h3> <ul fingerprint="060c7dea" fingerprint-exact="758484a3"> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tp17619.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tp17619.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tp17619.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Appointment for a New Problem </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa86803.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa86803.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa86803.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Daily Medicine Schedule </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zx4012.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zx4012.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zx4012.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Family Medical History Record </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2259.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2259.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2259.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> First Appointment </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2253.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2253.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2253.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Follow-Up Appointment </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa86905.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa86905.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa86905.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Master List of Medicines </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2257.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2257.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2257.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Medical Tests: Questions to Ask the Doctor </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2260.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2260.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2260.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> New Medicines: Questions to Ask the Doctor </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2258.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2258.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2258.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Other Treatment: Questions to Ask the Doctor </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2261.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2261.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2261.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Regular Checkup for a Child </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2262.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2262.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2262.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Regular Checkup for a Lifelong Condition </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zm2256.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zm2256.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zm2256.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Surgery: Questions to Ask the Doctor </span></a> <span class="NoWebPrint"> </span> </li> </ul> <h3 class="HwSubSectionTitle" fingerprint="3e381602" fingerprint-exact="d77a111a">Managing Diabetes</h3> <ul fingerprint="3bf4154e" fingerprint-exact="f83e3b6a"> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa95576.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa95576.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa95576.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Blood Sugar Testing Times Form </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tb1867.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tb1867.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tb1867.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Home Blood Sugar Diary </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_uq2696.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_uq2696.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_uq2696.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Form for Carbohydrate Counting </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zx3021.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zx3021.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zx3021.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Physical Activity Log </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_uq2705.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_uq2705.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_uq2705.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Record of My Child's High or Low Blood Sugar Problems </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa21125.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa21125.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa21125.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Record of My High Blood Sugar Emergency </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa20801.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa20801.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa20801.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Record of My Low Blood Sugar Problems </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa15771.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa15771.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa15771.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Tracking My Feelings About Diabetes </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_uq2638.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_uq2638.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_uq2638.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Using Low-Vision Aids at Home </span></a> <span class="NoWebPrint"> </span> </li> </ul> <h3 class="HwSubSectionTitle" fingerprint="51c69aa2" fingerprint-exact="356798d1">Plans</h3> <ul fingerprint="29137e47" fingerprint-exact="402a8e2a"> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tj2532.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tj2532.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tj2532.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> ADHD: Form for Establishing a Routine </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tj2475.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tj2475.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tj2475.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> ADHD: Sample School Plan </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tj2461.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tj2461.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tj2461.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> ADHD: Treatment Plan Record </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tj2794.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tj2794.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tj2794.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Alcohol Use: Plan to Stop Drinking </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zd1600.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zd1600.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zd1600.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Asthma Action Plan </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zx3727.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zx3727.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zx3727.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Exercise Planning Form </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_aa154666.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_aa154666.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_aa154666.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Meal Planning: Menu and Grocery List </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tj1498.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tj1498.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tj1498.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Parenting: Family Rules Form </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_ug5186.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_ug5186.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_ug5186.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Planning to Be More Active When You Have Chronic Disease </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_abl1753.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_abl1753.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_abl1753.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Pregnancy: My Birth Plan </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_zx3175.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_zx3175.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_zx3175.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Setting Goals: Personal Action Plan </span></a> <span class="NoWebPrint"> </span> </li> </ul> <h3 class="HwSubSectionTitle" fingerprint="2ea40dbe" fingerprint-exact="a7a40223">Screenings and Self-Tests</h3> <ul fingerprint="012c7d5b" fingerprint-exact="0f621d92"> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_ug3345.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_ug3345.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_ug3345.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Assess Your Substance Use </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tp23271.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tp23271.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tp23271.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Assess Your Tobacco Use </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tp23273.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tp23273.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tp23273.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> My Reasons to Quit Smoking </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_abn2339.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_abn2339.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_abn2339.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Self-Test For Anxiety </span></a> <span class="NoWebPrint"> </span> </li> <li> <a class="HwLinkExternal" data-hw-resource-path="media/pdf/hw/form_tp23272.pdf" href="https://ixbapi.healthwise.net/Resource/media/pdf/hw/form_tp23272.pdf?hw.format=rhtml&hw.key=AKCSXRU5GCWGPSRILP4CM2BJ3TSFZJX7ELHGLJFK4GC6YL5EBUUYOHQHOZMB7KH7HWSIM7XJXKG3H3JB5HVW5VI4CJW7522TLCOGH52I" hw:resource-path="media/pdf/hw/form_tp23272.pdf" hw:release-quarter="14.6"><span class="HwLinkText"> Stress: How Do You Cope? </span></a> <span class="NoWebPrint"> </span> </li> </ul> <h3 class="HwSubSectionTitle" fingerprint="12027540" fingerprint-exact="c29915e4"> 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