Before an appointment with your doctor, please fill out an Observation Log based on your most recent observations of your loved one.
Only a few minutes are needed to complete this form, but it will encourage clear communications between the doctor and you.
The Observation Log gives your doctor an update of your loved one's condition quickly, to make the most of your office visit. It will also help your doctor measure how effective the current treatment is, and decide if any adjustments are necessary.
Instructions:
Please place a tick inthe appropriate column to inform the doctor of changes observed in your loved one since the last visit or last dose adjustment. At the bottom, do the same to indicate how these changes have affected you. if not applicable or can't assess, check "No noticeable change from usual".
NOTE: No change, improvement, or even minimal decline are all positive signs of treatment effectiveness.
No noticeable change | Slight change | Significant change | |
Daily activities:
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Behaviour:
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Social:
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Thinking/memory:
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Impact on caregiver:
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For more information visit: Dementia SA: http://www.dementiasa.org/ or Alzheimer’s South Africa: http://www.alzheimers.org.za/