DR N RABOOBEE Dermatologist

Please bring this diary with you at every

ROACCUTANE DIARY

visit

Name

AGE

WGHT

DOSE

DATE

MONTH

MONTH

MONTH

MONTH

MONTH

MONTH

MONTH

Tick each day medication is taken

One tick per tablet

1

1

1

1

1

1

1

2

2

2

2

2

2

2

Please indicate the following:

3

3

3

3

3

3

3

Start of new box

N

4

4

4

4

4

4

4

Date of blood tests

B

5

5

5

5

5

5

5

Side effects

S

6

6

6

6

6

6

6

7

7

7

7

7

7

7

Record date of onset of side effects and

8

8

8

8

8

8

8

record details on back of this page

9

9

9

9

9

9

9

10

10

10

10

10

10

10

Contact details

11

11

11

11

11

11

11

12

12

12

12

12

12

12

Tel: 265 1505

13

13

13

13

13

13

13

14

14

14

14

14

14

14

Fax: 265 1644

15

15

15

15

15

15

15

16

16

16

16

16

16

16

e-mail: raboobee@iafrica.com

17

17

17

17

17

17

17

18

18

18

18

18

18

18

Web site: http://www.skinspecialist.co.za

19

19

19

19

19

19

19

Please read information on Roaccutane

20

20

20

20

20

20

20

on our web site

21

21

21

21

21

21

21

22

22

22

22

22

22

22

Essential vistis:

23

23

23

23

23

23

23

Before start of treatment

24

24

24

24

24

24

24

One month after starting

25

25

25

25

25

25

25

Four months after starting

26

26

26

26

26

26

26

Six months after starting

27

27

27

27

27

27

27

Additional visits may be necessary

28

28

28

28

28

28

28

depending on side effects

29

29

29

29

29

29

29

30

30

30

30

30

30

30

Please make your appointment well in

31

31

31

31

31

31

31

advance