Warfarin Worksheet



Warfarin Worksheet

Alpine Medical Group, Basalt & Aspen, CO

| | | |

|Name: __________________ | |Reason for Anticoagulation: __________________________ |

|ID #: ________________ |Primary MD: _____________ |Duration of Therapy: ____________ |

|Phone: ___ - ___ - ________ |Allergies: ________________ |INR Goal: _____________ File: Coumadin Flow Sheet Master.doc |

| | | | | | | |

| | |Warfarin Dose (mg/day) | | |Provider |Nurse |

Date |

INR |

Sun |

Mon |

Tue |

Wed |

Thu |

Fri |

Sat |

Coumadin Adjustment? |

Next INR Due |

(Use Initials) | |

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