Customizable Tools for your Clinical Practice
The Preventive Cardiovascular Nurses Association’s Customizable Clinical Forms includes downloadable PDF templates of clinical forms and patient handouts that you can use in your CVD risk reduction practice. These forms can be integrated into patient medical records. The tools include:
- Patient assessment forms
- Contracts
- Flow charts
- Follow-up plans and tools
- Patient education materials
- A list of online resource
How do I customize these forms?
Most of these forms include interactive fields in which you may enter patient and clinical information. We have created a sample and instructions for entering this information.
Patient Assessment
- [restrict level="logged-in-level"]Patient Assessment[/restrict][restrict level="!logged-in-level"]Patient Assessment [/restrict]
- [restrict level="logged-in-level"]Cardiovascular Risk Assessment Sheet[/restrict][restrict level="!logged-in-level"]Cardiovascular Risk Assessment Sheet [/restrict]
- [restrict level="logged-in-level"]Cardiovascular Risk Assessment Sheet continued[/restrict][restrict level="!logged-in-level"]Cardiovascular Risk Assessment Sheet continued [/restrict]
- [restrict level="logged-in-level"]Primary Prevention Patient Assessment Tool[/restrict][restrict level="!logged-in-level"]Primary Prevention Patient Assessment Tool [/restrict]
Flow Charts
- [restrict level="logged-in-level"]Flow Charts[/restrict][restrict level="!logged-in-level"]Flow Charts [/restrict]
- [restrict level="logged-in-level"]Cardiovascular Risk Assessment Flow Sheet[/restrict][restrict level="!logged-in-level"]Cardiovascular Risk Assessment Flow Sheet [/restrict]
- [restrict level="logged-in-level"]Cardiovascular Risk Assessment Flow Sheet continued[/restrict][restrict level="!logged-in-level"]Cardiovascular Risk Assessment Flow Sheet continued [/restrict]
Contracts and Self Monitoring Logs
- [restrict level="logged-in-level"]Contracts and Self-Monitoring Logs[/restrict][restrict level="!logged-in-level"]Contracts and Self-Monitoring Logs [/restrict]
- [restrict level="logged-in-level"]Self Contracts for Risk Factor Intervention[/restrict][restrict level="!logged-in-level"]Self Contracts for Risk Factor Intervention [/restrict]
- [restrict level="logged-in-level"]Written Agreement for Risk Factor Intervention Groups[/restrict][restrict level="!logged-in-level"]Written Agreement for Risk Factor Intervention Groups [/restrict]
- [restrict level="logged-in-level"]Daily Exercise Log[/restrict][restrict level="!logged-in-level"]Daily Exercise Log [/restrict]
- [restrict level="logged-in-level"]Daily Monitoring Log for Patients with Heart Failure[/restrict][restrict level="!logged-in-level"]Daily Monitoring Log for Patients with Heart Failure [/restrict]
Evaluation Tools
- [restrict level="logged-in-level"]Evaluation Tools[/restrict][restrict level="!logged-in-level"]Evaluation Tools [/restrict]
- [restrict level="logged-in-level"]Body Mass Index[/restrict][restrict level="!logged-in-level"]Body Mass Index [/restrict]
- [restrict level="logged-in-level"]National Cholesterol Education Program Adult Treatment Panel III[/restrict][restrict level="!logged-in-level"]National Cholesterol Education Program Adult Treatment Panel III [/restrict]
- [restrict level="logged-in-level"]Estimating 10 year Risk for Men and Women[/restrict][restrict level="!logged-in-level"]Estimating 10 year Risk for Men and Women [/restrict]
- [restrict level="logged-in-level"]Non-HDL-C[/restrict][restrict level="!logged-in-level"]Non-HDL-C [/restrict]
Peripheral Arterial Disease (PAD)
- [restrict level="logged-in-level"]Peripheral Arterial Disease (PAD)[/restrict][restrict level="!logged-in-level"]Peripheral Arterial Disease (PAD) [/restrict]
- [restrict level="logged-in-level"]Ankle-Brachial Index (ABI) Worksheet[/restrict][restrict level="!logged-in-level"]Ankle-Brachial Index (ABI) Worksheet [/restrict]
- [restrict level="logged-in-level"]Performing the ABI Test[/restrict][restrict level="!logged-in-level"]Performing the ABI Test [/restrict]
- [restrict level="logged-in-level"]Exercise Program for Individuals with PAD[/restrict][restrict level="!logged-in-level"]Exercise Program for Individuals with PAD [/restrict]
Diabetes
- [restrict level="logged-in-level"]Diabetes[/restrict][restrict level="!logged-in-level"]Diabetes [/restrict]
- [restrict level="logged-in-level"]Risk Factors or Complications and Recommended Treatment Goals and Frequency of Evaluation for Adults with Diabetes[/restrict][restrict level="!logged-in-level"]Risk Factors or Complications and Recommended Treatment Goals and Frequency of Evaluation for Adults with Diabetes [/restrict]
- [restrict level="logged-in-level"]Signs and Symptoms of Hypoglycemia[/restrict][restrict level="!logged-in-level"]Signs and Symptoms of Hypoglycemia [/restrict]
- [restrict level="logged-in-level"]Signs and Symptoms of Hyperglycemia[/restrict][restrict level="!logged-in-level"]Signs and Symptoms of Hyperglycemia [/restrict]
- [restrict level="logged-in-level"]Blood Glucose Monitoring Logs for Patients with Diabetes[/restrict][restrict level="!logged-in-level"]Blood Glucose Monitoring Logs for Patients with Diabetes [/restrict]
- [restrict level="logged-in-level"]Patient Lab Result Sheet[/restrict][restrict level="!logged-in-level"]Patient Lab Result Sheet [/restrict]
Nutrition
- [restrict level="logged-in-level"]Nutrition (Serving Size Card)[/restrict][restrict level="!logged-in-level"]Nutrition Serving Size Card [/restrict]
- [restrict level="logged-in-level"]Nutrition Record[/restrict][restrict level="!logged-in-level"]Nutrition Record [/restrict]
- [restrict level="logged-in-level"]Nutrient Content of Tree Nuts[/restrict][restrict level="!logged-in-level"]Nutrient Content of Tree Nuts [/restrict]
- [restrict level="logged-in-level"]Saturated Fat, Total Fat, Cholesterol, and Omega-3 Content of Meat, Fish, and Poultry[/restrict][restrict level="!logged-in-level"]Saturated Fat, Total Fat, Cholesterol, and Omega-3 Content of Meat, Fish, and Poultry [/restrict]
- [restrict level="logged-in-level"]Mediterranean Diet Food Guide[/restrict][restrict level="!logged-in-level"]Mediterranean Diet Food Guide [/restrict]
- [restrict level="logged-in-level"]Sample Menu American Cuisine - Male[/restrict][restrict level="!logged-in-level"]Sample Menu American Cuisine - Male [/restrict]
- [restrict level="logged-in-level"]Sample Menu American Cuisine - Female[/restrict][restrict level="!logged-in-level"]Sample Menu American Cuisine - Female [/restrict]
- [restrict level="logged-in-level"]Sample Menu Lacto-Ovo Vegetarian - Male[/restrict][restrict level="!logged-in-level"]Sample Menu Lacto-Ovo Vegetarian - Male [/restrict]
- [restrict level="logged-in-level"]Sample Menu Lacto-Ovo Vegetarian - Female[/restrict][restrict level="!logged-in-level"]Sample Menu Lacto-Ovo Vegetarian - Female [/restrict]
- [restrict level="logged-in-level"]Sample Menu Southern Cuisine - Male[/restrict][restrict level="!logged-in-level"]Sample Menu Southern Cuisine - Male [/restrict]
- [restrict level="logged-in-level"]Sample Menu Southern Cuisine - Female[/restrict][restrict level="!logged-in-level"]Sample Menu Southern Cuisine - Female [/restrict]
- [restrict level="logged-in-level"]Sample Menu Asian Cuisine - Male[/restrict][restrict level="!logged-in-level"]Sample Menu Asian Cuisine - Male [/restrict]
- [restrict level="logged-in-level"]Sample Menu Asian Cuisine - Female[/restrict][restrict level="!logged-in-level"]Sample Menu Asian Cuisine - Female [/restrict]
- [restrict level="logged-in-level"]Sample Menu Mexican-American - Male[/restrict][restrict level="!logged-in-level"]Sample Menu Mexican-American - Male [/restrict]
- [restrict level="logged-in-level"]Sample Menu Mexican-American - Female[/restrict][restrict level="!logged-in-level"]Sample Menu Mexican-American - Female [/restrict]
- [restrict level="logged-in-level"]The DASH Eating Plan Connection[/restrict][restrict level="!logged-in-level"]The DASH Eating Plan Connection [/restrict]
- [restrict level="logged-in-level"]My Pyramid[/restrict][restrict level="!logged-in-level"]My Pyramid [/restrict]
- [restrict level="logged-in-level"]Portion Control — How Much Food is Enough?[/restrict][restrict level="!logged-in-level"]Portion Control — How Much Food is Enough? [/restrict]
Stress Management
- [restrict level="logged-in-level"]Stress Management[/restrict][restrict level="!logged-in-level"]Stress Management [/restrict]
- [restrict level="logged-in-level"]Steps Required to Elicit the Relaxation Response[/restrict][restrict level="!logged-in-level"]Steps Required to Elicit the Relaxation Response [/restrict]
- [restrict level="logged-in-level"]Slow, Deep Breathing Practice[/restrict][restrict level="!logged-in-level"]Slow, Deep Breathing Practice [/restrict]
- [restrict level="logged-in-level"]Body Scan Exercise[/restrict][restrict level="!logged-in-level"]Body Scan Exercise [/restrict]
- [restrict level="logged-in-level"]Guided Imagery Practice- Going to a Special Place[/restrict][restrict level="!logged-in-level"]Guided Imagery Practice- Going to a Special Place [/restrict]
Follow-Up Tools
- [restrict level="logged-in-level"]Follow-Up Tools[/restrict][restrict level="!logged-in-level"]Follow-Up Tools [/restrict]
- [restrict level="logged-in-level"]Primary and Secondary Prevention Checklist[/restrict][restrict level="!logged-in-level"]Primary and Secondary Prevention Checklist [/restrict]
- [restrict level="logged-in-level"]Patient Lab Results[/restrict][restrict level="!logged-in-level"]Patient Lab Results [/restrict]
- [restrict level="logged-in-level"]Patient Plan[/restrict][restrict level="!logged-in-level"]Patient Plan [/restrict]
- [restrict level="logged-in-level"]Cardiovascular Risk Assessment Return Visit[/restrict][restrict level="!logged-in-level"]Cardiovascular Risk Assessment Return Visit [/restrict]
- [restrict level="logged-in-level"]Follow-Up Visit[/restrict][restrict level="!logged-in-level"]Follow-Up Visit [/restrict]
Patient Education
- [restrict level="logged-in-level"]Patient Education[/restrict][restrict level="!logged-in-level"]Patient Education [/restrict]
- [restrict level="logged-in-level"]Warning Signs for Heart Attack and Stroke[/restrict][restrict level="!logged-in-level"]Warning Signs for Heart Attack and Stroke [/restrict]
- [restrict level="logged-in-level"]Fit Walking into your Life with the 10,000 Steps a Day Program[/restrict][restrict level="!logged-in-level"]Fit Walking into your Life with the 10,000 Steps a Day Program [/restrict]
Medication Adherence
- [restrict level="logged-in-level"]Medication Adherence[/restrict][restrict level="!logged-in-level"]Medication Adherence [/restrict]
- [restrict level="logged-in-level"]Patient Medication Schedule[/restrict][restrict level="!logged-in-level"]Patient Medication Schedule [/restrict]
- [restrict level="logged-in-level"]Pearls for Medication Adherence: Patient Form[/restrict][restrict level="!logged-in-level"]Pearls for Medication Adherence: Patient Form [/restrict]
- [restrict level="logged-in-level"]Pearls for Medication Adherence: Professional Form[/restrict][restrict level="!logged-in-level"]Pearls for Medication Adherence: Professional Form [/restrict]
Exercise
- [restrict level="logged-in-level"]Exercise[/restrict][restrict level="!logged-in-level"]Exercise [/restrict]
- [restrict level="logged-in-level"]Benefits of Exercise/Physical Activity[/restrict][restrict level="!logged-in-level"]Benefits of Exercise/Physical Activity [/restrict]
- [restrict level="logged-in-level"]How to Start an Exercise Program[/restrict][restrict level="!logged-in-level"]How to Start an Exercise Program [/restrict]
- [restrict level="logged-in-level"]Exercise: Goal Setting[/restrict][restrict level="!logged-in-level"]Exercise: Goal Setting [/restrict]
- [restrict level="logged-in-level"]Tips for Sticking With It![/restrict][restrict level="!logged-in-level"]Tips for Sticking With It! [/restrict]
- [restrict level="logged-in-level"]Exercise Program for Individuals with Heart Disease[/restrict][restrict level="!logged-in-level"]Exercise Program for Individuals with Heart Disease [/restrict]
- [restrict level="logged-in-level"]Exercise Tips for Individuals with Heart Disease[/restrict][restrict level="!logged-in-level"]Exercise Tips for Individuals with Heart Disease [/restrict]
- [restrict level="logged-in-level"]Exercise for Healthy Older Adults: Benefits[/restrict][restrict level="!logged-in-level"]Exercise for Healthy Older Adults: Benefits [/restrict]
- [restrict level="logged-in-level"]Exercise for Healthy Older Adults: Getting Started[/restrict][restrict level="!logged-in-level"]Exercise for Healthy Older Adults: Getting Started [/restrict]
- [restrict level="logged-in-level"]Exercise for Healthy Older Adults: Safety First[/restrict][restrict level="!logged-in-level"]Exercise for Healthy Older Adults: Safety First [/restrict]
- [restrict level="logged-in-level"]Exercise for Healthy Older Adults: Measuring Your Progress[/restrict][restrict level="!logged-in-level"]Exercise for Healthy Older Adults: Measuring Your Progress [/restrict]
- [restrict level="logged-in-level"]Exercise Goal-Setting Worksheet[/restrict][restrict level="!logged-in-level"]Exercise Goal-Setting Worksheet [/restrict]
- [restrict level="logged-in-level"]Weekly Exercise and Physical Activity Plan[/restrict][restrict level="!logged-in-level"]Weekly Exercise and Physical Activity Plan [/restrict]
- [restrict level="logged-in-level"]Endurance Daily Record[/restrict][restrict level="!logged-in-level"]Endurance Daily Record [/restrict]
- [restrict level="logged-in-level"]Activity/Exercise Log/Journal[/restrict][restrict level="!logged-in-level"]Activity/Exercise Log/Journal [/restrict]
- [restrict level="logged-in-level"]Patient Exercise Prescription[/restrict][restrict level="!logged-in-level"]Patient Exercise Prescription [/restrict]
- [restrict level="logged-in-level"]Behavioral Management Strategies for Initiating and Maintaining Exercise Adherence[/restrict][restrict level="!logged-in-level"]Behavioral Management Strategies for Initiating and Maintaining Exercise Adherence [/restrict]
Information on Smoking Cessation
- [restrict level="logged-in-level"]Information on Smoking Cessation[/restrict][restrict level="!logged-in-level"]Information on Smoking Cessation [/restrict]
- [restrict level="logged-in-level"]Getting Started: Ten Key Guideline Recommendations[/restrict][restrict level="!logged-in-level"]Getting Started: Ten Key Guideline Recommendations [/restrict]
- [restrict level="logged-in-level"]Always Identify and Assess Tobacco Users in Your Practice[/restrict][restrict level="!logged-in-level"]Always Identify and Assess Tobacco Users in Your Practice [/restrict]
- [restrict level="logged-in-level"]The 5As Model for Treating Tobacco Use and Dependence[/restrict][restrict level="!logged-in-level"]The 5As Model for Treating Tobacco Use and Dependence [/restrict]
- [restrict level="logged-in-level"]For the Patient Willing to Quit[/restrict][restrict level="!logged-in-level"]For the Patient Willing to Quit [/restrict]
- [restrict level="logged-in-level"]FDA-Approved Smoking Cessation Medications[/restrict][restrict level="!logged-in-level"]FDA-Approved Smoking Cessation Medications [/restrict]
- [restrict level="logged-in-level"]Promoting the Motivation to Quit for the Patient Unwilling to Quit[/restrict][restrict level="!logged-in-level"]Promoting the Motivation to Quit for the Patient Unwilling to Quit [/restrict]
- [restrict level="logged-in-level"]Recommendations to Clinicians When Addressing Weight Gain[/restrict][restrict level="!logged-in-level"]Recommendations to Clinicians When Addressing Weight Gain [/restrict]
- [restrict level="logged-in-level"]Seven Steps for People Who Want to Quit Smoking[/restrict][restrict level="!logged-in-level"]Seven Steps for People Who Want to Quit Smoking [/restrict]
- [restrict level="logged-in-level"]Log for Tracking My Smoking Habit[/restrict][restrict level="!logged-in-level"]Log for Tracking My Smoking Habit [/restrict]
- [restrict level="logged-in-level"]Plan for Your Smoking Urges: What to Do Instead of Smoking![/restrict][restrict level="!logged-in-level"]Plan for Your Smoking Urges: What to Do Instead of Smoking! [/restrict]
- [restrict level="logged-in-level"]How to Administer and Score the Smoking Confidence Questionnaire: For the Healthcare Professional[/restrict][restrict level="!logged-in-level"]How to Administer and Score the Smoking Confidence Questionnaire: For the Healthcare Professional [/restrict]
- [restrict level="logged-in-level"]Smoking Confidence Questionnaire[/restrict][restrict level="!logged-in-level"]Smoking Confidence Questionnaire [/restrict]
- [restrict level="logged-in-level"]Tips for When You Have Stopped Smoking or Relapsed[/restrict][restrict level="!logged-in-level"]Tips for When You Have Stopped Smoking or Relapsed [/restrict]
Hypertension - Ambulatory and Home Blood Pressure Monitoring
- [restrict level="logged-in-level"]Hypertension - Ambulatory and Home Blood Pressure Monitoring[/restrict][restrict level="!logged-in-level"]Hypertension - Ambulatory and Home Blood Pressure Monitoring [/restrict]
- [restrict level="logged-in-level"]Ambulatory Blood Pressure Monitoring For the Clinician[/restrict][restrict level="!logged-in-level"]Ambulatory Blood Pressure Monitoring For the Clinician [/restrict]
- [restrict level="logged-in-level"]Home Blood Pressure Monitoring For the Clinician[/restrict][restrict level="!logged-in-level"]Home Blood Pressure Monitoring For the Clinician [/restrict]
- [restrict level="logged-in-level"]Home Blood Pressure Monitoring For Patients[/restrict][restrict level="!logged-in-level"]Home Blood Pressure Monitoring For Patients [/restrict]
- [restrict level="logged-in-level"]Home Blood Pressure Monitoring For Patients- Sphygmomanometers for Self-measurement of Blood Pressure[/restrict][restrict level="!logged-in-level"]Home Blood Pressure Monitoring For Patients- Sphygmomanometers for Self-measurement of Blood Pressure [/restrict]
Models of Behavior
- [restrict level="logged-in-level"]Models of Behavior[/restrict][restrict level="!logged-in-level"]Models of Behavior [/restrict]
- [restrict level="logged-in-level"]Assessing Readiness To Change - Transtheoretical Model[/restrict][restrict level="!logged-in-level"]Assessing Readiness To Change- Transtheoretical Model [/restrict]
- [restrict level="logged-in-level"]Self-Efficacy for the Professional: Understanding the Theory Concept[/restrict][restrict level="!logged-in-level"]Self-Efficacy for the Professional: Understanding the Theory Concept [/restrict]
- [restrict level="logged-in-level"]Goal Setting Tips for Lasting Lifestyle Change for the Patient[/restrict][restrict level="!logged-in-level"]Goal Setting Tips for Lasting Lifestyle Change for the Patient [/restrict]
- [restrict level="logged-in-level"]Goal Setting Worksheet for the Patient[/restrict][restrict level="!logged-in-level"]Goal Setting Worksheet for the Patient [/restrict]
- [restrict level="logged-in-level"]The General Self-Efficacy[/restrict][restrict level="!logged-in-level"]The General Self-Efficacy [/restrict]
Searching the Internet for Cardiovascular Resources
- [restrict level="logged-in-level"]Searching the Internet for Cardiovascular Resources[/restrict][restrict level="!logged-in-level"]Searching the Internet for Cardiovascular Resources [/restrict]
- [restrict level="logged-in-level"]National Organizations and Major University Sites[/restrict][restrict level="!logged-in-level"]National Organizations and Major University Sites [/restrict]
- [restrict level="logged-in-level"]Specific Topics (Aging, Physical Fitness, Obesity, Nutrition and Weight Loss)[/restrict][restrict level="!logged-in-level"]Specific Topics (Aging, Physical Fitness, Obesity, Nutrition and Weight Loss) [/restrict]
- [restrict level="logged-in-level"]Pediatric Obesity[/restrict][restrict level="!logged-in-level"]Pediatric Obesity [/restrict]
- [restrict level="logged-in-level"]Smoking Cessation, Evidence Based Practice[/restrict][restrict level="!logged-in-level"]Smoking Cessation, Evidence Based Practice [/restrict]
Lipid Reference Values
- [restrict level="logged-in-level"]Lipid Reference Values[/restrict][restrict level="!logged-in-level"]Lipid Reference Values [/restrict]
- [restrict level="logged-in-level"]Lipid Reference Values — Serum Total Cholesterol[/restrict][restrict level="!logged-in-level"]Lipid Reference Values — Serum Total Cholesterol [/restrict]
- [restrict level="logged-in-level"]Lipid Reference Values— Serum LDL[/restrict][restrict level="!logged-in-level"]Lipid Reference Values— Serum LDL [/restrict]
- [restrict level="logged-in-level"]Lipid Reference Values — Serum HDL[/restrict][restrict level="!logged-in-level"]Lipid Reference Values — Serum HDL [/restrict]
- [restrict level="logged-in-level"]Lipid Reference Values — Serum Triglycerides[/restrict][restrict level="!logged-in-level"]Lipid Reference Values — Serum Triglycerides [/restrict]
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Disclaimer: Please be aware that these forms include a sample of current clinical guidelines. However, clinical guidelines (federal, state, local, or those issued by clinical organizations) change over time, so the reader should remember to investigate any recent legal or clinical developments.
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