Education and care-planning support only — does not replace clinical judgment or local protocols.

🩺 CP-LONG — Long-Term Condition Check

Self-management of chronic illness. · Group T Long-term illness · Links to: T1–T8

Original tool, not yet validated. Pilot and review with clinicians before clinical decisions. Supports, but does not replace, clinical judgment, validated scales and local policy.

Patient

Date/Time

Nurse

Item	0	1	2
Knows condition	0 · Yes	1 · Partly	2 · No
Takes medicines as prescribed	0 · Always	1 · Sometimes misses	2 · Often misses
Monitors self (BP, sugar, weight)	0 · Regularly	1 · Sometimes	2 · Never
Attends follow-up	0 · Always	1 · Sometimes	2 · Rarely
Lifestyle (diet, smoking, activity)	0 · Healthy	1 · Some risks	2 · Many risks

⚠ Red flags — escalate at once regardless of score

No specific red flags listed — use clinical judgment.

Total: 0 — select a score for each item

Score	Level	Action
0–2	Good	Encourage
3–6	Fair	Teaching plan, set 1–2 goals
≥7	Poor	Specialist nurse / clinic referral

Nursing notes / action taken

⬇ Blank form (PDF)