Keep track of important phone numbers, treatment history, chemo side effects, and laboratory results, such as your complete blood count (CBC) or the medicines you are taking. Knowing these may help you to understand and manage your care.

Use these worksheets to help organize this information so you can be an active participant in your cancer care.

Getting Started Questions Worksheet

Your healthcare team is your best source of information. To make sure you get the answers you deserve about your disease, your treatment, possible risks, and the best protection, it's important to find out as much as you can by reading, learning, and asking. This list will help you get started understanding what questions might come up. When you have a question, write it down and save it for the next time you talk to you doctor.

Blood Cell Tracker

Keep track of your blood cell counts so you can speak with your doctor about what can be done. Your goal is to avoid side effects that could create delays or interruptions in your therapy.

Important Contacts

Store contact information for your doctor, caregivers, nutritionist, and other members of your healthcare team as well as the people who are supporting you in other ways during your chemotherapy.

Notes From Doctors' Visits

To get the most from your chemotherapy, you and your healthcare team must work together to determine the best medication, dose, and schedule for your specific condition. You may be taking multiple medications, and when combined with one or more other drugs, any medication can produce additional effects beyond those intended. Keep accurate records of your doctor visits. Write down the questions you ask and the answers you get.

Medicine Tracker

Keep track of what medicines you are taking, how often, and what side effects you have. This can help you speak with your doctor and care team about chemo side effects. Your goal is to avoid side effects that could create delays or interruptions in your therapy.

Support Network Scheduler

Make a list of persons willing to help in case you need it. This worksheet gives you a place to write down names and contact information, task involved, and dates or times of participation. This can help you stay organized during chemo. You can give copies of the list to key people like family members and caregivers.

Side Effects Tracker

Keep track of any chemo side effects you experience. Ask your doctor about each side effect and write down the information on the worksheet.

Calendar

Keep track of medical and personal appointments using this handy calendar.

Health History Planner

You will speak to many providers during your time in chemo. This document helps you keep track of your tumor type, stage or grade, surgical history and treatments, plus any medications you are taking. Bring this planner with you, so that you can accurately relate your health history.

Insurance Discussion Record

Medical insurance and bill management can be frustrating. Most hospitals and clinics provide a patient services representative to assist you with such issues. You can keep track of and record the results of these conversations in the Insurance Discussion Record.

All-in-One Packet

Download all of these worksheets at once in this handy all-in-one document.

  • The Chemotherapy and Infection Discussion Guide can help you understand your
    chance for infection

    Infection can be a serious result of chemo. Find out the factors that affect your chance of infection. Simply answer a few questions, and then print your results to share with your doctor.

    Use the Chemotherapy and Infection Discussion Guide to find out more.

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