TYPE OF FLOW
Patient: _______________________________________
X
Normal
Address: _______________________________________
O
Exceptionally light
___________________________Phone: ______________
Exceptionally heavy
Year: ________ Doctor: ___________________________
S
Spotting
1
2
3
4
5
6
7
8
9
10
11 12
13
14 15
16 17
18
19
20 21 22
23 24
25
26
27 28
29 30
31
Jan.
Feb.
Mar.
Apr.
May
Jun.
Jul.
Aug.
Sep.
Oct.
Nov.
Dec.
Don’t forget to have this chart with you when you call or visit your doctor.