A cardiovascular risk reference guide, Framingham global risk assessment scoring guide, cardiovascular checklist, and cardiovascular risk-reduction treatment plan.
Patient's name________________________________________________________
Chart #______________
Date___________________
Please complete pages 1, 2, and 3 during the patient's first office visit. Place in front of the patient's chart.
CARDIOVASCULAR RISK FACTORS
Nonmodifiable
Modifiable
ORGAN DAMAGE ASSESSMENT
HYPERTENSION ASSESSMENT
Identifiable causes of hypertension or secondary hypertension (when indicated)
OTHER ASSESSMENTS