HealthRX.com · Printable side-effect diary
Ozempic caregiver weekly injection and symptom diary
For a caregiver who gives weekly Ozempic to an older adult. Use it to record each injection, the site used, and any vomiting, diarrhea or poor drinking, then bring it to the prescriber or pharmacist.
Person receiving Ozempic
Copy these details from the pharmacy label and prescriber records.
Date of birthDay, month and year
Current dose step on the pen labelCopy exactly as written
Allergies and other conditions
Before the visit
Gather these items and bring them to the appointment.
- Bring the Ozempic pen box and the pharmacy label
- Bring every other medicine, including insulin or sulfonylurea tablets
- Note the day of the week the injection is usually given
- Check with the pharmacist about the pen storage and needle plan
- Write down any missed injection and the date it was due
- Bring this diary with all recorded weeks filled in
Weekly injection and symptom record
Fill in one row for each weekly injection and each day with symptoms.
| Date | Site used | Vomiting or diarrhea | Fluids drunk | Low sugar signs | Notes |
|---|---|---|---|---|---|
Questions for the prescriber or pharmacist
- Does the dose step stay the same for an older adult with this health history?
- What should we do if vomiting or diarrhea starts after an injection?
- When should we call about poor drinking or fewer trips to the toilet?
- What should we do if a weekly injection is missed?
- Should we change any other diabetes medicine when Ozempic is given?
- Which low blood sugar signs should we watch for at home?
- Which thyroid or stomach symptoms should prompt a call?
- How often should kidney tests be done during treatment?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.