33
Attachment B - Patient Diary
Shown below is an example of a patient diary for patients to fill out during their individual
pH studies. Explain the importance of the proper use of the patient diary. Let the patient
know that (s) he can go about his or her daily routine as usual. Instruct your patient to fill
in the diary for meals and sleep periods using the time from the clock displayed on the Dx–
Recorder™. This will ensure that the diary times entered in the Dx–DataView™ software
are correct when the patient’s pH study is analyzed.
Patient Diary
Restech Dx–pH Measurement System™
Study
Patient Code
Investigation Date
All Meals
Begin Time
End Time
What I Ate
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Snack
Lying Down
Begin Time
End Time
Remarks
Time
Time
Time
Time
Significant
Symptom
Begin Time
End Time
Description
1
3
4
5
6
7
8
9
10
11
12
Summary of Contents for Dx-pH Measurement System
Page 2: ...2 Dx pH Measurement System User s Manual Version X X August 2005...
Page 21: ...21...
Page 28: ...28 Click OK when the desired settings have been selected...
Page 32: ...32 Attachment A Patient Instructions...
Page 34: ...34...
