CA II CommunityFamily Care Toolkit · v1.0 · 10 September 2026
Follow-up Visit Checklist
Since the last visit — what you notice at home only. Do not treat any symptom as proof of a specific HCO3 or K level.
| Item | Better | Same | Worse | Unsure |
|---|---|---|---|---|
| Activity | ||||
| Lethargy | ||||
| Unusual hyperactivity | ||||
| Fatigue | ||||
| Appetite | ||||
| Amount of food | ||||
| Nausea | ||||
| Constipation | ||||
| Diarrhea | ||||
| Vomiting | ||||
| Abdominal pain | ||||
| Urine amount | ||||
| Urine frequency | ||||
| Urine color | ||||
| Urine odor | ||||
| Pain/burning with urination | ||||
| Nocturnal enuresis | ||||
| Dark appearance under eyes / appearance change | ||||
| Specific pain | ||||
| Mood | ||||
| Psychological state | ||||
| Medication acceptance | ||||
| Missed/delayed doses | ||||
| Spitting medicine | ||||
| School/social behavior | ||||
| Vision | ||||
| Hearing |
Usual order of the visit day (approximate)
1 Registration2 Weight/height3 Clinic4 Blood gas/labs5 Return to clinic6 Evaluate results7 Evaluate dose8 Review symptoms9 Medication/nutrition advice if needed10 Next appointment
Today’s lab results
| Previous visit | Today | Doctor’s decision | |
|---|---|---|---|
| pH | |||
| HCO3 | |||
| K | |||
| Na |
Dose decision:
UnchangedIncreasedDecreasedFormulation changed
Potassium:
No changeDietary adviceMedication prescribed by physician
Before leaving the clinic
New dose writtenPrescription renewedNext appointment bookedNext lab date knownKidney follow-up date checkedImaging follow-up checkedImportant question answered
After-visit summary
Educational and organizational only. Does not diagnose, set doses, or replace a clinician. What you notice at home is not the same as what is in the medical record, and not the same as what the doctor decides.