Warfarin Worksheet
Warfarin Worksheet
Alpine Medical Group, Basalt & Aspen, CO
| | | |
|Name: __________________ | |Reason for Anticoagulation: __________________________ |
|ID #: ________________ |Primary MD: _____________ |Duration of Therapy: ____________ |
|Phone: ___ - ___ - ________ |Allergies: ________________ |INR Goal: _____________ File: Coumadin Flow Sheet Master.doc |
| | | | | | | |
| | |Warfarin Dose (mg/day) | | |Provider |Nurse |
Date |
INR |
Sun |
Mon |
Tue |
Wed |
Thu |
Fri |
Sat |
Coumadin Adjustment? |
Next INR Due |
(Use Initials) | |
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