MY CARE DIARY
RESOURCES
• To schedule or reschedule my appointments , I should call :_______________________________________________
_______________________________________________________________________________________________
• I should bring to my appointments :__________________________________________________________________
_______________________________________________________________________________________________
LIST OF FUTURE APPOINTMENTS
Date :___________________________________________________________________________________________
Time :___________________________________________________________________________________________
Location :________________________________________________________________________________________
Provider :________________________________________________________________________________________
Purpose :________________________________________________________________________________________
_______________________________________________________________________________________________
SUPPLIES OR EQUIPMENT NEEDED
• I will need :_____________________________________________________________________________________
_______________________________________________________________________________________________
• If I need more supplies , I should call :_________________________________________________________________
_______________________________________________________________________________________________
26 Patient & Visitor Guide