Sheet1

**TOP PRIORITY TASK FOR THE DAY**

PRIORITIES & TASKS ACHIEVED:

Woke Up: SLEEP QUALITY: # TIMES WOKEN BY: URGE TO PEE / POO: 1 2 3 4 5 6 7 8 9 10 +
Bed Time: SLEEP TOT HRS: DOG: [1] [2] [3] [4] [+] NAUSEA / VOMITING: 1 2 3 4 5 6 7 8 9 10 +
(Alarm) (Natural) REFRESHED? [Y] [N] [P] JOSH: [1] [2] [3] [4] [+] PAIN / DISCOMFORT: 1 2 3 4 5 6 7 8 9 10 +
[Partially / Medicated]

MENTAL HEALTH: Moods: PAIN Types + Locations:

Depression: Morning:
Anxiety: Evening:
Panic Attack: Overall #:
SOS Meds: [Y] [N] SOS Meds? [Y] [N]
Non-Verbal: Mobility: [L] [M] [H] Means of Mobility:
Social: Desire: Actual:
Nausea: Meds: Urination: Color: 1 2 3 4 5 6 7 8 9 10 +
Vomiting: Defecation: Bristol Type: 1 2 3 4 5 6 7 8 9 10 +

WIND: Speed + Direction, Gusts + Direction DEW POINT: TEMPERATURE / RealFeel Dawn:
High: High: PRESSURE: High: Sunrise:
Low: Low: THUNDER: [Y] [N] [P] Low: Sunset:
Average: Average: Avg: Moonrise:
PRECIPITATION: Chance, Rate, Total Accumulation, Type(s) GENERAL FORECAST: Moonset:
Moonphase:
UV INDEX: CLOUD COVER: AIR QUALITY INDEX: Illumination:

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HUMIDITY: VISIBILITY: HOLIDAY: [Y] [N] [E/D]

POLLEN/POLLUTANT Type(s) + Count(s): WHICH:
Candles:
3 Stars:
ADDITIONAL NOTES:

Today's Date is:

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 Sheet1

AID NEEDED? [Y] [N] DID I DRESS: [A] [U] [NA]

TYPE: BRUSH TEETH: [A] [U] [NA]
BATHE/SHOWER: [A] [U] [NA]

HYDRATION OUTSIDE TIME: (Y) (N)

1L: [1] [2] [3] [4] How Much?
2L: [1] [2] [3] [4] Activity Type(s):
3L: [1] [2] [3] [4]
FOOD LOG: [Y] [N] [P]

MEDS: [AM] [PM] [SOS]

SUPPLEMENTS: [AM] [PM]
FIBER: [Y] [N] [NEED]

PHYSIO? [Y] [N] [P] WHAT I GOT DONE TODAY

(Routine) (Other)
Total Time:
Start Time:
NOTES:

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Sheet1

DAILY LOG

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 DAILY LOG 1

**TOP PRIORITY TASK FOR THE DAY**

PRIORITIES & TASKS ACHIEVED:

PAIN (+ TYPES & LOCATIONS) MOODS HYDRATION BEVERAGE TYPES:

1L: [1] [2] [3] [4]
2L: [1] [2] [3] [4]
3L: [1] [2] [3] [4]

FOOD LOG:

ADDITIONAL NOTES:

Today's Date is: DAILY LOG pg ___ of ___

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 DAILY LOG CHECKOFF

WHAT DAY NIGHT MOBILITY AIDS USED TODAY INCLUDE: WOKE UP: SLEEP NOTES
IXEL BEDTIME:
BETAHISTINE
DICLECTIN TIMES WOKEN BY:
ZOFRAN YN URINE COLOR: 01234567+ DOG 1 2 3 4 5 +
PRENATALS Y N EXCREMENT BRISTOL TYPE: 01234567+ JOSH 1 2 3 4 5 +
B-12 PEE/POO 1 2 3 4 5 +
FOLEX MED NOTES: CHANGES? NAUSEA 1 2 3 4 5 +
NORMALAX [Y] [N] [NEED] VOMIT 1 2 3 4 5 +
MAGNESIUM PAIN 1 2 3 4 5 +
POTASSIUM
ZINC MOVEMENT NOTES: CHANGES? AID NEEDED TO FALL ASLEEP
OUTSIDE TIME [Y] [N] [NEED] [Y] [N] WRITE TYPE(S) BELOW
EXERCISE
PHYSIO

LOW MOD HIGH SOS MEDS? INDEPENDENT NEEDS HELP DEPENDENT DOES NOT DO
NAUSEA BATHING
VOMITING DRESSING
DEPRESSION GROOMING
ANXIETY ORAL CARE
PANIC TOILETING
TRANSFERRING
PAIN: AM WALKING
PAIN: NOON CLIMBING STAIRS
PAIN: EVENING EATING
PAIN: NIGHT SHOPPING
COOKING
MOBILITY MANAGING MEDICATIONS
SOCIAL DESIRE USING THE PHONE
SOCIAL ACTUAL HOUSEWORK
DOING LAUNDRY
SLEEP QUALITY DRIVING
SLEEP QUANTITY MANAGING FINANCES

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DAILY LOG CHECKOFF

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 DAILY WEATHER ETC

WIND: Speed + Direction, Gusts + Direction DEW POINT: TEMPERATURE / RealFeel DAWN:
High: PRESSURE: High: SUNRISE:
Low: THUNDER: [Y] [N] [P] Low: SUNSET:
Average: Avg: MOONRISE:
PRECIPITATION: Chance, Rate, Total Accumulation, Type(s) GENERAL FORECAST: MOONSET:
MOONPHASE:
UV INDEX: CLOUD COVER: AIR QUALITY INDEX: ILLUMINATION:
HUMIDITY: VISIBILITY: HOLIDAY: [Y] [N] [E/D]
POLLEN/POLLUTANT Type(s) + Count(s): WHICH:
CANDLES:
3 STARS:

Today's Date is: DAILY LOG pg ___ of ___

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