Hypertension Chronic Care Management Plan
Student Name:Sex: M or FDate of Birth:Date of Entry:Initial Blood PressureBlood Pressure Target:140/90 or greater - hypertension120/80 or less - idealInitial Weight:Initial BMI:Co-Morbid Conditions:Reminders:Explain the consequences of hypertensionReview medications and adverse effectsRefer to TUPP, IDT, the counselor/case manager , and Hypertension Wellness groupSet goals with patient (weight loss and exercise, avoid excessive alcohol, TUPP, and salt intake/diet)BLOOD PRESSURE AND SELF MANAGEMENTDATEEVERY 3 MONTHSBlood PressureSmoking: YesNoActivity level (at least 30 min, 5 days/week)Salt intakeAlcohol consumptionWeight (Target = _ )SleepTESTSAT LEAST ANNUALLYFasting glucose or glycohemoglobinMicroalbumin (urine)Total cholesterolHDL-CLDL-CTriglyceridesMEDICATIONS/EFFECTSDiuretic):Calcium channel blocker:Beta blocker:Combination:ACE inhibitor:Other: ................
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