Be In Charge Patient Diary

It is important for both you and your doctor to see how your hepatitis C treatment is advancing - for you to see how you are accomplishing your treatment goals, and for your doctor to ensure that your treatment is hitting the mark. Management of your treatment is key; your Patient Diary will help you meet that goal.

Request Your Patient Diary. A comprehensive patient diary booklet is available by mail, simply request it from your personal nurse counselor at Be In Charge. In the meantime, a one page Patient Diary is available right here, printable from this website. You can use your Patient Diary to keep track of your doctor and lab visits, when you took medication, any side effects you might experience and your mood at various times in the treatment process. Your diary will let your doctor know of your physical symptoms to determine if something is out of the ordinary or indicates a complication that should be tested. Your Patient Diary can be one of your best treatment management tools.

Track Your Progress. You can use your Patient Diary to keep track of your doctor and lab visits, when you took medication, any side effects you might experience and your mood at various times in the treatment process. Your diary will let your doctor know of your physical symptoms to determine if something is out of the ordinary or indicates a complication that should be tested. Your Patient Diary can be one of your best treatment management tools.

What is in this Patient Diary?

Each Patient Diary page covers one full week, so you can print out the page one at a time or all at once, then place the complete diary page in your Be In Charge® Workbook for ready retrieval. Each week has a place to indicate:

• Doctor visits, lab work, pregnancy tests and therapy milestones.
• Your latest injection site.
• When you took your prescription.
• Noticeable side effects.
• Your general mood on a particular day.
• Your overall mood for a week.
• Any over-the-counter medications you took that week, including vitamins, herbals and supplements.
• Notes to yourself or your doctor.

Effective hepatitis C treatment means taking a disciplined approach to improving your condition. Receive regular e-mail reminders that will notify you when to perform certain treatment-related activities, such as when it's time to administer medication, meet with your health care provider or refill your prescription.

To get started, please choose one of the following:   I have been diagnosed with hepatitis C, but haven't started treatment yet I am on treatment for hepatitis C     * Note: If you or someone you know may be at risk for hepatitis C, please visit www.peg-intron.com See Instructions   Select one of the choices above and click "Next"

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