COPD Patient Monitoring Checklist
Patient Name:
Date:
Clinician:
Symptoms Assessment
Symptom
Present
Notes
Cough
Sputum Production
Shortness of Breath
Wheezing
Fatigue
Vital Signs
Measurement
Value
Respiratory Rate (breaths/min)
Heart Rate (bpm)
Oxygen Saturation (%)
Blood Pressure
Temperature (°C)
Medication Adherence
Inhaler(s) taken as prescribed
Oral medications taken as prescribed
Recent Exacerbations
Increase in symptoms
Hospital or ER visit
Other Notes