Warfarin Management Progress Note

Patient Name…………………………………………………..
DOA…………………………………………………………..
Date of start dose………………………………………………
Chief Complaint:
Here to follow-up on management of chronic anticoagulation.
___________________________________________________
Current dosage of warfarin:  ……….. mg/day, OR -…………………………………………..

*Select whether patient’s dosing is based on a specific day of the week, or based on a cycle (cross out extra days if cycle <7), then enter dose.
*
* Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Recent INR Result: …………………….

History:
Indication(s) for warfarin: No complaints
Atrial fibrillation
Cerebrovascular disease Unusual bleeding Bruising Chest pain
Confusion Epistaxis Falls/injuries
Clotting disorder
Hematochezia Hematemesis Hematuria
Congestive heart failure Hemoptysis Melena Menstrual 
Deep vein thrombosis Pain/swelling in LE SOB
Mechanical heart valve Other ____________
Peripheral vascular disease
Pulmonary embolism _______________________________________________________
Other………………………………….
_______________________________________________________
Date warfarin started: ___/ ___/___ _______________________________________________________
INR Goal range:
2.0 – 3.0 _______________________________________________________
2.5 – 3.5 Dietary ? Y N Weight ? Y N
Other: __________ Does patient know current dosage regimen? Y N
Expected Duration of Rx:
Physical Exam:
Indefinitely VS: Wt: ____ T: ____ BP ___/ ___ P: ____
Skin: No bruising ______________________________
3 months Lungs: Clear ______________________________
Cardio: RRR, Nl S1S2 ______________________________
3-6 months No M,G,R _________________________
Abd: Normal _________________________
Ext: No edema ______________________________
Other: ___________
No cords ______________________________
Other: ____________________________________________
____________________________________________
Medication (other than warfarin):
No other medication

See updated medication list

Allergies:

None

See Summary List

Warfarin Management Progress Note
Plan: Continue current dose of warfarin NEXT LAB TEST: ___/___/____ at ___ am pm
Modify dose of warfarin as noted below: F/U in office: ___ days ___ weeks ___months
* Select whether patient’s dosing is based on a specific day of the week, or based on a cycle (cross out extra days if cycle <7), then enter dose.
*
* Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

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Signature/Professional Designation & Date Doctors Signature/