Patient Self-Care Tracking Sheet
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Name: _________________________ Date of Implant: _____________ Device Model: ___________________ Serial Number: _______________
Target Range: ______ to ______ beats per minute
| Date | Time | Pulse Rate | Symptoms/Notes |
|---|---|---|---|
Temperature if symptoms present: _______°F
Date of check: ____________ Magnet Rate: _____________ BPM
Cardiologist: _________________ Phone: ________________ Device Clinic: ________________ Phone: ________________
Device Check: ________________ Cardiologist Visit: ___________
Contact your healthcare provider immediately if you experience any warning signs
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