Antipsychotic Metabolic Monitoring Checklist Form
Complete this checklist to document key metabolic monitoring for individuals prescribed antipsychotic medication. Do not enter sensitive identifiers.
Patient Initials
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Antipsychotic Medication Name
*
Weight (kg)
BMI
Blood Pressure (mmHg)
Fasting Glucose (mg/dL)
Lipid Panel Completed?
Yes
No
Waist Circumference (cm)
Comments / Notes
Submit
Should be Empty: