Annual Review questionnaire for CVD Review (blood pressure, stroke, heart disease and chronic kidney disease)

It is important for you to complete the required information for your review. We need this to ensure your medications remain effective and also to discuss any changes which may be beneficial to your health. Without this information we may not be able to continue issuing your medications in the usual way.

Annual Review questionnaire for CVD Review (blood pressure, stroke, heart disease and chronic kidney disease)

Section

Blood pressure Reading

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Smoking

Do you smoke?

Weight

Medication

Are you taking all your medications as prescribed?
Do you understand the purpose of each of your medications?
Are you able to take your medication as directed on the labels?
Are your medicines effective in controlling your symptoms?
Do you have any problems which if addressed would assist you in taking your medications?
Have you stopped taking any medications?
Do you buy Aspirin and take daily?