Self-Care Checklist

Step 1 – Assess the problem.

→     How long ago did you notice the problem?  What symptoms are present?  ___________________________________________________

           ___________________________________________________

           ___________________________________________________

→     How long have you had these symptoms?                                               

→     Where is the pain located and how would you describe it?  

           ___________________________________________________

           ___________________________________________________

→   Determine your vital signs:

§ Body Temperature __________                      

§ Breaths per minute __________

§ Heart Rate ___________ beats per minute    

§ Blood Pressure (if possible)  _________/__________

→     If you have experienced this problem before what actions did you take? 

          _____________________________________________________

           _____________________________________________________

→     Could this problem have been caused by a recent change in your life? 

        Does anyone you know have the same symptoms?

          _____________________________________________________

           ____________________________________________________

Step 2 – Educate yourself.

→     Use the Mayo Clinic Guide to Self-Care or other books or internet resources

      (i.e. WebMD) to learn more about the symptoms you are experiencing.

→     Ask those you know for opinions and advice.  Ask both professional and non-

      professional people.

→    What is it that you think is wrong?                                                                     

-          What have you done for Self-Care?  Any over the counter medications?

           ______________________________________________________________

           ______________________________________________________________

→     What do you think is the best course of action for this?

           ______________________________________________________________

           ______________________________________________________________

Step 3 – Reassess the problem.

→    After a period of time, how have your symptoms progressed? Better or worse? ________________________________________________________

          ________________________________________________________

Some considerations before, during, and after a visit to a health care provider:

Before the visit:

-    Complete the self-care checklist above.

-    Provide a list of any medications you are taking (OTC and prescription).

During the visit:

-    Describe your primary health problem.

-    Use the checklist to describe the symptoms present, and what you have  

   already done to treat the problem.

After the visit:

-    Record:

o        What the health care provider determined the problem was.

o        What suggestions he/she gave you for self-care at home.

o        Any drugs, tests, or treatments recommended and their possible side

      effects/risks/alternatives.