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Personal Prevention Chart

Savvy Consumer - Personal Prevention Chart
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Use this Personal Prevention Chart to keep track of the preventive care that you have received and/or will need in the future. With the help of your health care provider, fill in how often you need each type of preventive care. Write in the date and results of tests each time you receive preventive care.

Personal Prevention Chart

Type of Care How Often Goal Date and Results
(example)
Blood Pressure
Once a month 130/70 8/12/98
140/80
         
Blood Pressure                
Cholesterol                
Weight                
Dental Visits                
Vision                

Return to Regular Checkups: Teeth and Gums, Cholesterol, Oral Cancer
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