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List Forms eBook

Do you have a handy list of your medications?  Your medical providers? Your important contacts?  How about a log to track your INR results? If not, read on. 

You can use the forms on this page to keep track of them so you and your loved ones can manage your Coumadin®/Warfarin and your health.

Each form is available in 2 formats:

  • If you prefer paper records, download and print the PDF version.
  • If you would like to modify a form on your computer, download the Microsoft Word version.

Download your free eBook of list forms HERE.

INR Tracking Log

When you take warfarin, your blood must be tested to determine the speed of its clotting action.  The INR measurement is a result of the Prothrombin Time blood test. It indicates the rate of blood clotting as compared to someone who does not take warfarin.

Maintaining your INR within your prescribed therapeutic range is critical to avoiding dangerous blood clots while avoiding excessive bleeding. INR levels can be difficult to control, so tracking test results, dosage changes, and the date of your next test will help you stay on track.

You can use this form to track your INR and identify trends that will help you to keep your INR in the right therapeutic range for you.

Download forms HERE.

Personal Contacts List

Even if your important contacts are on speed dial, if you have an emergency or are without your cell phone you and everyone close to you need an easily accessible list of important contacts.  If you can’t call, someone else may need to make arrangements, such as caring for your pet or watering your plants.

You can use this list so other important people in your life know who to call, even if you cannot.  

Download forms HERE.

List your Service Providers

According to Wikipedia, service providers are organizations that provide consulting, legal, real estate, communications, storage, and processing. Your list should also include anyone who provides you or your home with services, such as utilities, landlord, and people who cut the grass and remove the snow.

Complete the list with your service providers and post it where it can easily be referenced.  You will need handy access to important services in case of emergency.  And, other people will be able to act on your behalf, for example if you are admitted to the hospital or a recuperation facility.

Download forms HERE.

List All Your Healthcare Providers

Why keep a list of all your healthcare providers?  The most important reason is to ensure your family knows who to contact in case of emergency.  You know which doctors to call but your family probably does not. Another reason you need a list of your healthcare providers is to ensure you have informed all of them that you take Coumadin®/Warfarin.  Finally, the list will help you and your family informed of upcoming appointments.

Your medical team includes all the professionals who care for you, prescribe medications, and even alternative providers who such as massage therapists.  The download is a starter list.  Add all your providers, including those who provide alternative care.

Download forms HERE.

Your Medications, Vitamins, and Supplements

If you cannot name every medicine, vitamin, and supplement (including herbs) you take, you need a list.  And, you need to discuss the complete list with all your medical providers.  This will help them to more effectively manage your care.

You should include vitamins, supplements, and herbs on your list because there are many substances that interfere with the effectiveness of Warfarin.  This is not a problem for any you take daily, but can significantly change your INR if you take them infrequently.  

Download the form and use it to record details of all medicines, supplements, vitamins, and herbs that you take.

Download forms HERE.

Plan your Meals

Coumadin® (Warfarin) works by restricting Vitamin K, a nutrient that is found in green leafy vegetables, soy, legumes, and many other foods.  Vitamin K is used by your body to form blood clots.  By limiting Vitamin K, Warfarin slows the rate at which your body creates clots.

Vitamin K is also required for proper absorption of calcium, so long-term effects of Vitamin K deficiency can cause osteoporosis and arteriosclerosis.   To avoid this, you should balance foods high in Vitamin K with foods that slow blood clotting. When taking any form of Warfarin, your diet should be balanced and consistent. 

Use this form to plan your healthy diet to stay on track while taking Warfarin.

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