Preparing
for my doctor visit
Date
Greeting
say hello to your doctor.
What
Questions do you have for your doctor?
What
symptoms have you been having since your last doctor appointment?
What
are my lab results?
T-Cell Count Viral
load
Resistance
Test What am I resistant to.
Combivir
Epivir (3TC)
Hivid (DDC)
Retrovir (AZT)
Videx (DDI)
Ziagen (Abacavir)
Trizivir
Sustiva (Efavirenz)
Viramune (Nevirapine)
Rescriptor (Delavirdine) Agenerase
(Amprenavir)
Crixivan (Indinavir) Fortovase
(saquinavir)
Norvir (Ritonavir)
Cholesterol
Was this in the normal
range
Pap Smears Results
Other
Medical Conditions of importance to me.
Name of Condition
Other Lab Results Important to me
Name of test?
Were the results in the normal range
What does this effect?
What can I do to help improve it?
Medical
findings from the physical examination
Choosing
my medication. What is important to me?
Number of
pills:
I
Want the least amount possible
I
will take more pills to meet my other requirements
The
number of pills isn’t a concern to me.
Food Restrictions:
I
want to eat when I take my medicine to help me remember.
I
don’t want to have to eat when taking my medicine
I
don’t care
Number of times a day to take medicine:
Once
A Day
Twice
A Day
Three
A Day
Effectiveness of the regiment:
I want the most effective regiment
I
am willing to sacrifice effectiveness to meet my other needs.
Side effects I would prefer not to get due to my lifestyle
Diarrhea
Nausea Vomiting
Rash
Kidney Stones
Headaches
Elevated
Liver Enzymes
Hair Loss
Peripheral Neuropathy
Fatigue
Anxiety
Confusion
Insomnia
Nightmares
Paranoia
Stomach Upset
Lipodystophy
What kind
of work I do
What medicines I have been on and presently taking now.
Norvir (Ritonavir)