Acute Disseminated Encephalomyelitis (ADEM) Support Group

Medical Forms and Trackers


Thanks to Renie, moderator of LWTN, for sharing the links of the basic forms and worksheets that can help you organize your medical information and also prepare for a doctor visit.

Here's the list:

38-Doctor_Visit_Preparation_Sheet.pdf (55.8 KB)

39-Medical_History.pdf (59.6 KB)

40-Medication_Log.pdf (72.3 KB)

41-Allergy_Tracker.pdf (78.7 KB)

42-Surgical_History_Record.pdf (72.5 KB)

43-Family_Medical_History_Form.pdf (84.5 KB)

44-Pain_Tracker.pdf (32.7 KB)

45-Sleep_Diary_Adult.pdf (128.3 KB)

46-Physical_Activity_Tracker.pdf (142.7 KB)

47-Mood_Tracker.pdf (70.6 KB)

48-Blood_Sugar_Tracker.pdf (103.7 KB)

49-Blood_Pressure_Chart.pdf (50.6 KB)

50-Walletsized_Medical_Information_Card.pdf (68.9 KB)

51-Health_Information_Release_Authorization_Form.pdf (192.0 KB)

52-hipaafaxcoversheet.doc (50.5 KB)

53-Medical_Bill_And_Expenses_Tracker.pdf (89.8 KB)