Long-term Conditions review
You have been invited to complete this review to help manage your long-term conditions. The first part will gather some lifestyle information and ask questions about medicines in general. In the second section you will be able to select the long-term conditions relevant to you and answer important questions. It is best to set aside at least 20 minutes to complete all the sections. Your answers will always be seen by the practice team, and you can indicate at the end of each relevant section if you feel further discussion is needed.

CONTENTS:
- Asthma
- COPD (breathing)
- Diabetes
- Rheumatoid Arthritis
- Epilepsy
- Coronary heart disease

YOU NEED: recent weight and height.

OPTIONAL:
Blood pressure: You can submit blood pressure readings if you take them yourself. Ideally two readings twice a day over 4-7 days (max 30). Alternatively you may be able to check your blood pressure at the practice, but please call first to check.

Blood sugar: You can submit your home blood sugar readings here. Please take a reading before each meal (breakfast, lunch and dinner) and before bed for 4-7 days

For both blood sugar and blood pressure readings it works best to gather all your readings before completing this review

Rheumatoid arthritis only:
Before you start you can do an OPTIONAL self-assessment. You will require a recent blood test result (CRP or ESR). Please visit:
bit.ly/RheumScore Guide to the DAS28 score
bit.ly/RheumApps You can download the mobile app to calculate your score

SAFETY: Your answers will be attached to your medical record but may not be seen immediately. This system should never be used if you are in need of urgent medical attention. In this event, please contact the appropriate services (999 or 111) or the practice as normal.
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Practice Name - OFFICE USE ONLY *
This review is only for patients registered at the practice below. Please do not alter
Data Processing Notice
Participation
To participate in this online review you must confirm the following by ticking each box. If you are unable to do so please contact the practice
First name *
Surname *
Month of birth *
Day of birth *
Year of birth *
How would you like to enter your weight? *
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