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Personal Cholesterol Management Tracker

Monitor Your Heart Health Progress

Cardiology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: //___

Target Goals

  • Total Cholesterol: < 200 mg/dL
  • LDL ("Bad") Cholesterol: < 100 mg/dL
  • HDL ("Good") Cholesterol: > 40 mg/dL (men), > 50 mg/dL (women)
  • Triglycerides: < 150 mg/dL

Tracking Table

Date Total LDL HDL Triglycerides Notes

Lifestyle Modifications

Diet Changes

  • Reduced saturated fats: □ Yes □ No
  • Increased fiber intake: □ Yes □ No
  • Limited processed foods: □ Yes □ No

Physical Activity

Weekly Exercise Goals: ____ minutes

Actual Minutes: Week 1: _____ Week 2: _____ Week 3: _____ Week 4: _____

Medications

Current Medications:

  1. _________________ Dose: _______ Time: _______
  2. _________________ Dose: _______ Time: _______

Next Appointment

Date: //___ Time: ________

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