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My 360° Health Trackers

Time of Incident

Hours

:

Minutes

AM/PM

Date of Incident

MM slash DD slash YYYY

What would you like to track today?

Click on the items you would like to track, then scroll down to complete the sections below.

Pain Crisis

Weather Tracker

Mood Tracker

Hydration

Treatment Tracker

Medications Tracker

Vital Signs

Allergy

My Lab Results

Pain Crisis

What type of Pain Crisis did you have?

It's best to track one symptom at a time

Tired

Cramping

Pain

Headache

Leg Swelling

Bruising

Sharp Pain

Dull Pain

Other

What other symptom are you experiencing?

What part of the body is the pain?

Full Body Ache

Head

Eyes

Shoulders

Arms/Hands

Upper Back

Lower Back

Chest

Stomach

Pelvic Region

Legs

Feet

What were you doing when this symptom occured?

Sudden Change of temperature

Working at computer

Exercising

Relaxing

Dealing with Stress

Dehydrated

Sleep Deprivation

Other

What other activity triggered this pain?

Rate your Pain for this Symptom Pre-treatment (1-Low, 10-High):

Weather Tracker

Weather Tracker: How was the weather when your symptom(s) started?

Hot (91°F or more)

Mild (61°F - 90°F)

Cold (60°F or below )

Hydration Tracker

How was your hydration at time of symptom onset?

Fully Hydrated

Sort of hydrated

Poorly hydrated

Overly Hydrated

Mood Tracker

What was your mood before pain?

Happy

Decent

Neutral

Not good

Very tired

Terrible

Vital Signs Tracker

What is your Blood Pressure: Systolic mm Hg (Upper Number)

What is your Blood Pressure: Diastolic mm Hg (Lower Number)

What is your pulse Oximeter Reading?

IMPORTANT NOTICE - HYPERTENSIVE STAGE

You are receiving this message because your systolic blood pressure reading over 180 is considered Hypertensive. Please seek medical attention as soon as possible.

IMPORTANT NOTICE - HYPERTENSIVE STAGE

You are receiving this message because your diastolic blood pressure reading over 90 is considered Hypertensive. Please seek medical attention as soon as possible.

What is your pulse/heartbeat per minute?

Count your pulse for 15 seconds and multiply by 4

Please enter a number from 4 to 25.

What is your body temperature?

Count your pulse for 15 seconds and multiply by 4

Please enter a number from 80 to 110.

MyTreatment Tracker

Treatments

Prescription Medicine

Nonprescriptive Medicine

Exercise

Psychological Counseling

Physical Therapy

Prayer or Meditation

Herbal Remedies

Massage

Relaxation Technique

Hot Packs

Cold Packs

Rest

Sauna

Other

What other treatment did you do?

What kind of prescription medicine did you take?

Hydroxyurea

L-glutamine Oral Powder (Endari)

Antibiotics (e.g., Penicillin)

Crizanlizumab (Adakveo)

Voxelotor (Oxbryta)

Other

What other prescription did you take?

What kind of non-prescription medicine did you take?

Tylenol (acetaminophen)

Aspirin (ASA)

Advil (NSAID)

Vitamin

Other

What other non-prescription did you take?

Rate your Symptom #1 Pain hour after treatment (1-Low, 10-High)

Please enter a number from 0 to 10.

On a scale of 1-10, what is your pain level now, one hour after your self-treatment?

Mood After Pain Treatment

Excited and happy

Ok...feeling decent

Neutral - not ecstatic, but not down at all

Angry

Tired

Upset or Stressed

My SCD Medication Tracker

What prescription medicine did you take?

It's best to track one medication at a time.

Hydroxyurea

L-glutamine Oral Powder (Endari)

Antibiotics (e.g., Penicillin)

Crizanlizumab (Adakveo)

Voxelotor (Oxbryta)

Other

What other prescription medicine did you take?

When did you take your medicine?

Morning

Afternoon

Evening

Bedtime

Other

What other prescription did you take?

My Allergy Tracker

What would you like to do today?

What are you Allergic to?

Medication

Food

Insect Stings

Pets

Dust

Mold

Latex

Blood Transfusion

Other

What other item are you allergic to?

What medicine are you allergic to had a side effect?

Hydroxyurea

L-glutamine Oral Powder (Endari)

Antibiotics (e.g., Penicillin)

Crizanlizumab (Adakveo)

Voxelotor (Oxbryta)

Other

What foods are you allergic to?

Almond

Cow’s milk

Egg white

Egg yolk

Peanut

Shrimp/Shellfish

Soy

Tuna

Wheat

Other

Type of Reaction

Itchy Eyes

Rash

Facial Swelling

Difficulty breathing

Anaphalaxis

Stomach Upset

Other

What other prescription did you take?

What medicine caused an allergy?

Hydroxyurea

L-glutamine Oral Powder (Endari)

Antibiotics (e.g., Penicillin)

Crizanlizumab (Adakveo)

Voxelotor (Oxbryta)

Other

What other medicine caused the allergy?

Rate Severity of Reaction (1-low and 10-high)

Please enter a number from 1 to 10.

My Lab Results

Type of Lab Test

Numeric Results

Additional Notes about this Pain Incident?

Upload photo

Max. file size: 100 MB.

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My 360° Health Trackers

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