Doctor:_______________________
Phone:________________________
CONDITION NAME: Self-Care Plan
Green = In Control
GREEN
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Green Means:
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Put
Symptoms
Here
Put
What
To
Do
Here
Yellow = Caution
YELLOW
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Put
Symptoms
Here
Yellow Means:
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Put
What
To
Do
Here
Physician Contact:
Doctor:_______________________
Phone:________________________
Red = Medical Alert!
RED
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
Put
Symptoms
Here
Red Means:
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Put
What
To
Do
Here
Add important information here