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8607 Roberts Drive, Suite 150 Sandy Springs, GA 30350-2237

(770) 518-8272phone    (770) 518-3310fax

8607 Roberts Drive, Suite 150 Sandy Springs, GA 30350-2237


Step 29: Record the infusion on your treatment calendar



  • Write the infusion on your treatment calendar as soon as you finish.
  • Once you’ve completed your treatment calendar, it can be sent or taken to your Hemophilia Treatment Center. Talk to the HTC nurse to find out about faxing or emailing your calendars.

Hemophilia of Georgia provides a treatment calendar as a PDF file and as a Microsoft Word document.  If you use Microsoft Word you can save the Word document on your computer and then type in your treatment information. If you don’t have Word or would prefer to write on the form instead of typing, just print out the PDF file.

What information to put on the calendar

The treatment calendar includes space for you to record:

  • the date of each treatment
  • the brand name of the factor you used
  • the lot number
  • the expiration date
  • the amount of medication used.

Sometimes, this information is included on a removable label on the vial of clotting factor. If you’d like, you can stick the label right on the calendar and just write in the rest of the information. You might need to skip lines if the label is too wide to fit in the box.

In the box labeled Prophylaxis?, please write Yes if the treatment was a regular, routine infusion or write No if the treatment was for an injury or bleed.

In the box that says Current Bleed? Where?, please write Yes if the treatment was needed because of a bleed. And, if it was, please indicate the location of the bleed, such as right elbow or left ankle

In the box that says Pain Scale, please indicate the level of pain associated with bleed or injury, if any.

Finally, in the last box, please write in the name of the person who gave the infusion. If it is a self-infusion, please write Self.

Consider keeping a health diary

You may find it helpful to keep a simple diary of your health care.  This will be useful when you are telling someone your medical history.  This record could include:

  • Dates of bleeds
  • Brief descriptions of bleeds
  • Hospital stays (including the name of the hospital)
  • Medical tests done
  • Names and addresses of doctors you see.