A warfarin flow sheet is the anticoagulation record for one patient: why they take warfarin, their INR target, and a dated row for every INR with the dose decided, the reason, and the next test. Copy the free template, see an atrial fibrillation patient whose INR jumped on an antibiotic and a patient starting warfarin after a mechanical mitral valve, and check what goes in each part.
Blank warfarin flow sheet template
FreeWARFARIN FLOW SHEET Patient: [Name, date of birth] Weight and kidney function: [Weight, eGFR or creatinine clearance, and the date] Managed by: [Clinician, pharmacist, or nurse responsible, and the clinic's direct line] Pharmacy: [Name and phone] INDICATION AND TARGET Indication: [Atrial fibrillation, deep vein thrombosis, pulmonary embolism, mechanical valve and its position, or other] Stroke and bleeding risk: [Scores used, such as CHA2DS2-VASc and HAS-BLED, with the date, or not applicable] Target INR range: [2.0 to 3.0 for most indications; 2.5 to 3.5 for a mechanical mitral valve, or the range the cardiologist set] Why warfarin: [Mechanical valve, another reason a DOAC doesn't suit, or the patient's choice after discussion] Start date: [Date of the first dose] Planned duration: [3 months, 6 months, indefinite, or lifelong, and the date to review it] Bridging at the start: [Heparin or enoxaparin, the dose, and the rule for stopping it, or none] Other drugs that add to bleeding: [Aspirin, other antiplatelets, NSAIDs, SSRIs, or none] TABLETS AND TESTING Tablet strength at home: [Strength in mg and its color; one strength only where possible] How the INR is tested: [Lab draw, clinic fingerstick, or home self-testing, and the meter] Testing interval: [Every few days at the start, then weekly, then up to every 4 weeks once steady, or as agreed] INR TABLE One row per INR, newest last. Doses in mg per week, with the dose for each day. Date | INR | Weekly dose and daily schedule | Change | Reason or factors | Bleeding or clot symptoms | Next INR | Who was told and how [Date] | [INR] | [mg per week; mg on each day] | [No change, doses held, or percent up or down] | [Missed or extra doses, new medicine, diet, alcohol, illness, or none found] | [None, or what and what was done] | [Date] | [Patient, caregiver, or prescriber; phone, portal, or in person] [Date] | [INR] | [mg per week; mg on each day] | [Change] | [Reason or factors] | [Bleeding or clot symptoms] | [Date] | [Who was told and how] [Date] | [INR] | [mg per week; mg on each day] | [Change] | [Reason or factors] | [Bleeding or clot symptoms] | [Date] | [Who was told and how] [Date] | [INR] | [mg per week; mg on each day] | [Change] | [Reason or factors] | [Bleeding or clot symptoms] | [Date] | [Who was told and how] TIME IN THERAPEUTIC RANGE Method: [Rosendaal linear interpolation, or the share of INRs in range] Period: [First and last dates counted, leaving out the first weeks of starting warfarin] TTR: [Percent of days in range over that period] If below goal: [Causes found, and the plan: adherence aids, more frequent tests, home testing, or whether a DOAC would suit] INTERACTIONS AND OTHER FACTORS Interacting medicines now: [Each drug, its expected effect on the INR, and the plan] Recent starts and stops: [Antibiotics, antifungals, amiodarone, or others, with dates] Supplements and herbal products: [Each one, or none] Diet and alcohol: [Usual leafy greens and other vitamin K foods, recent changes, and drinks a week] Health changes: [Fever, diarrhea, poor appetite, heart failure, liver disease, or a thyroid change] INTERRUPTIONS AND PROCEDURES Planned procedures: [Procedure, date, and who performs it] Hold plan: [Last dose before, bridging if any, and when and at what dose to restart] Missed doses: [Dates, and what the patient did] EDUCATION CHECKLIST Why warfarin, and the target range: [Date taught, and by whom] Dose calendar and one tablet strength: [Date] Missed dose: [Take it later the same day; never double up the next day; date taught] Warning signs: [Bleeding, stroke, and clot signs, and when to call 911 or go to an emergency department; date] Food and alcohol: [Keep vitamin K intake steady rather than avoid it; alcohol limits; date] New medicines: [Tell every prescriber, pharmacist, and dentist; ask before any new medicine, supplement, or herbal product; date] Falls and medical ID: [Fall risk discussed, and a medical alert card or bracelet; date] Pregnancy: [Contraception and pregnancy plans where relevant, as warfarin can harm a fetus, or not applicable] REVIEW Next INR: [Date and place] Indication review: [Date to confirm warfarin is still needed and still the best choice] Updated by: [Name, credentials, date]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Primary care anticoagulation clinic, pharmacist-led, May to November 2026
71-year-old man, retired electrician. Persistent atrial fibrillation since 2016. Hypertension, on amlodipine 5 mg; no heart failure, diabetes, stroke, or vascular disease. CHA2DS2-VASc 2: age 71 and hypertension. HAS-BLED calculated and recorded at his yearly review in March; no past bleeding. Target INR 2.0 to 3.0. Started May 2016; duration indefinite, reviewed each March. Offered a DOAC in March 2026; he chose to stay on warfarin, as his INRs have been steady for years. Weight 84 kg; eGFR 64 in March 2026. No aspirin or other antiplatelet; told to avoid ibuprofen and naproxen.
5 mg tablets only, halved when a 2.5 mg dose is needed. Clinic fingerstick INR every 4 weeks since 2023.
May 26, 2026 | 2.5 | 35 mg; 5 mg every day | No change | None found | None | Jun 23 | Him, in clinic. Jun 23 | 2.3 | 35 mg | No change | None found | None | Jul 21 | Him, in clinic. Jul 21 | 2.8 | 35 mg | No change | More wine than usual at a family reunion that weekend | None | Aug 18 | Him, in clinic. Aug 18 | 2.6 | 35 mg | No change | None found | None | Sep 15 | Him, in clinic. Sep 15 | 2.4 | 35 mg | No change | None found | None | Oct 13 | Him, in clinic. Oct 13 | 2.7 | 35 mg | No change | None found | None | Nov 10 | Him, in clinic. Oct 22 | 4.6 | 30 mg; hold tonight’s dose, then 5 mg daily except 2.5 mg on Mondays and Fridays | 1 dose held; weekly dose down 14% | Trimethoprim-sulfamethoxazole double strength twice daily for 7 days, started Monday Oct 19 by urgent care for a urinary tract infection. The pharmacist flagged the interaction, and he called the clinic the same day, so this INR was booked for day 4. No missed or extra doses, eating normally, no alcohol this week | None: no nosebleeds, bleeding gums, visible blood in urine, black stools, or new bruising | Oct 27 | Him, by phone, schedule read back; dose calendar sent to the portal. Oct 27 | 2.9 | 35 mg; back to 5 mg every day from tonight | Back to his usual dose | Antibiotic finished Oct 25; urine symptoms gone | None | Nov 3 | Him, by phone, read back. Nov 3 | 2.6 | 35 mg | No change | None found | None | Nov 17 | Him, in clinic.
Rosendaal method, May 26 to November 3, 2026, from the rows above: 161 days. Every day up to October 13 counts as in range. Between October 13 and October 27, about 12 days are estimated above 3.0. TTR 92%. Above the clinic’s goal of 70%, so no change to his plan or test interval for that reason.
Trimethoprim-sulfamethoxazole raises the INR by slowing the breakdown of warfarin; expected to wear off within about a week of the last dose, so his usual dose went back once the course ended. Amlodipine: no meaningful effect. Acetaminophen: 500 mg twice a day on 2 days for the urinary symptoms; told that 2 g a day or more for several days can also raise the INR. Supplements and herbal products: none; asked about fish oil and turmeric. Diet: a salad most days, unchanged. Alcohol: 2 or 3 drinks a week. Health changes: the infection only; no fever, diarrhea, or loss of appetite.
No procedures planned. Missed doses: none since May.
Reviewed by phone on October 22. What a high INR means, and to call 911 or go to an emergency department for a severe headache, vomiting blood, black stools, bleeding that won’t stop, or a fall with a blow to the head. Told him calling the day the antibiotic started was exactly right, and to do the same for any new medicine. Dose calendar and one tablet strength: reviewed. Missed dose plan, vitamin K, alcohol, and medical alert card: covered in March, unchanged. Urgent care clinic sent a copy of this entry, asking that the anticoagulation clinic be called whenever an interacting antibiotic is started.
INR back in range on his usual 35 mg a week, with no bleeding. Next INR November 17; if 2.0 to 3.0, back to every 4 weeks. Indication and DOAC review: March 2027. Updated by: clinic pharmacist, November 3, 2026.
Primary care anticoagulation clinic, from hospital discharge, October and November 2026
58-year-old woman, school librarian. Mechanical bileaflet mitral valve replacement on October 5, 2026, for rheumatic mitral stenosis. Sinus rhythm. Hypothyroidism on levothyroxine 75 mcg. Target INR 2.5 to 3.5, aiming for 3.0, as set by her cardiac surgeon and cardiologist. Duration: lifelong. Why warfarin: DOACs are not used with mechanical heart valves. Low-dose aspirin: not started; her cardiologist will decide at the 6-week visit. Weight 70 kg; eGFR 82 at discharge. Bridging: intravenous heparin in hospital, then enoxaparin 70 mg twice daily, 1 mg/kg, from discharge until the INR is 2.5 or higher on 2 checks at least 24 hours apart, per the surgeon’s discharge plan. Hospital course, from the discharge summary: baseline INR 1.1; warfarin 5 mg nightly from October 6; INR 1.2 on Oct 8, 1.5 on Oct 9, 1.8 on Oct 10. Discharged Sunday, October 11, on 5 mg nightly.
5 mg tablets only, halved for 2.5 mg doses. Lab draws near her home, results to the clinic the same afternoon. Testing plan: every 2 or 3 days until in range on 2 checks, then twice a week, then weekly, then every 2 weeks, stretching to every 4 weeks once steady.
Oct 13 | 2.2 | 35 mg; 5 mg every day | No change | Day 8 of warfarin, rising steadily on this dose; no missed doses; eating normally | Small bruises at enoxaparin sites; chest wound dry; no other bleeding | Oct 15 | Her, by phone. Oct 15 | 2.6 | 35 mg | No change | First result in range; enoxaparin continues until a second | None | Oct 16 | Her, by phone. Oct 16 | 2.8 | 35 mg | No change; enoxaparin stopped after this morning’s dose | Second in-range result, 24 hours after the first | None | Oct 19 | Her, by phone; surgeon’s office told. Oct 19 | 3.8 | 32.5 mg; 5 mg daily except 2.5 mg on Mondays, starting tonight | Down 7% | Still rising as the dose settles; no missed or extra doses, diet steady, no new medicines | None; no new shortness of breath, no change in the valve’s click, no weakness or trouble speaking | Oct 22 | Her, by phone, schedule read back. Oct 22 | 3.3 | 32.5 mg | No change | None found | None | Oct 26 | Her, by phone. Oct 26 | 3.1 | 32.5 mg | No change | None found | None | Nov 2 | Her, by phone. Nov 2 | 3.0 | 32.5 mg | No change | None found | None | Nov 16 | Her, in clinic.
Not reported during the start. Three INRs in a row were in range on the same dose by November 2, so the clinic counts her TTR from that date, by the Rosendaal method, and reports it from her 3-month review.
Levothyroxine: dose unchanged; any change in her thyroid dose can shift the INR, so it goes on this sheet. Pain: acetaminophen 500 mg to 1 g once or twice a day for wound pain, stopped by October 26; told to avoid ibuprofen and naproxen. Antibiotics: none since discharge. Supplements and herbal products: none; she stopped a turmeric capsule before surgery and won’t restart it. Diet: appetite back to normal by October 15; greens most days, kept steady. Alcohol: none since surgery.
None planned. Any procedure that needs warfarin stopped will have a plan from her cardiologist; with a mechanical mitral valve, a hold usually needs bridging. Dental work: antibiotic prophylaxis for her valve, as her cardiologist advises; cleanings and fillings go ahead on warfarin, with an INR in the week before. Missed doses: none.
Taught at discharge by the hospital pharmacist, and reviewed by the clinic on October 13 and November 2: why warfarin is lifelong with her valve; the target of 2.5 to 3.5; one tablet strength, halved on Mondays; a missed dose is taken later the same day, never doubled the next day. Warning signs: bleeding signs; and call 911 for new shortness of breath, a change in the valve’s click, sudden weakness, a drooping face, or trouble speaking. Steady leafy greens, alcohol limits, and calling before any new medicine or supplement. Medical alert bracelet ordered. Pregnancy: not applicable, postmenopausal. Home INR self-testing discussed for later; she is interested once her dose is steady.
In range on 3 checks on 32.5 mg a week. Next INR November 16; if 2.5 to 3.5, every 2 weeks, then every 4 weeks. Cardiology visit November 19, about 6 weeks after surgery. Updated by: anticoagulation nurse, November 2, 2026.
Why the patient takes warfarin, the INR range every result is read against, and how long it is meant to go on.
Avoid: Leaving the target off the sheet. A result of 2.6 is in range for atrial fibrillation and below range for a mechanical mitral valve.
The tablet the patient has at home, how the INR is measured, and how often.
Avoid: Two tablet strengths at home. Patients mix up colors and take the wrong dose; use one strength and halves where you can.
One row per INR, oldest first, so the run of results sits next to every dose decision and its reason.
Avoid: “Same dose” with no number. Write the weekly total and the daily schedule in every row, so a misread dose shows up.
The share of time the INR spent in range over a set period: the main measure of how well warfarin is working for this patient.
Avoid: Quoting a TTR with no period or method. Rosendaal and the share of INRs in range give different numbers from the same results.
Everything that can push the INR up or down, so a result out of range has an explanation before the dose changes.
Avoid: Asking only about prescriptions. Herbal products, supplements, and pain relievers bought at a pharmacy change the INR too.
Planned procedures, and the hold and restart plan for each, with missed doses.
Avoid: Stopping warfarin for a procedure without asking whether it needs stopping. Many dental cleanings and fillings go ahead on warfarin.
What the patient has been taught, by whom, and when, so gaps are easy to spot.
Avoid: Teaching once at the start and never again. Review it after any high INR, bleed, or new interacting medicine.
The next test, and when to look again at whether warfarin is still the right drug.
Avoid: A sheet that runs for years with no review of the indication. A clot treated for 3 months may no longer need warfarin.
“One tablet daily” stops meaning anything when the strength changes. Write the weekly total in mg and the dose for each day, and keep the patient on one tablet strength.
Ask about missed or extra doses, new medicines and supplements, diet, alcohol, and illness first. A one-off cause usually needs a held dose or a small change, not a large permanent one.
A dose lowered for an antibiotic needs a plan for the day the course ends: when the usual dose comes back, and an INR within about a week.
Ask at every INR, even one in range, and write the answer. Bleeding at a normal INR needs a search for a cause, such as a lesion in the gut or urinary tract.
Every row ends with the next test date and who was told. Without it, a missed test goes unnoticed. Check the list of overdue patients each week.
Vero Scribe writes the flow sheet entry in your template from the call or visit, with the patient’s consent, or from your dictation. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
Also called an anticoagulation flow sheet or INR log, it is the running record for one patient on warfarin. It holds the indication, target INR range, start date, and planned duration, then a row for every INR with the weekly dose, any change and its reason, bleeding or clot symptoms, the next test date, and who was told. Add time in therapeutic range, interacting medicines, procedures, and an education checklist. A patient’s own INR log can be simpler: the date, the INR, and the dose to take each day until the next test.
For most patients, including atrial fibrillation, deep vein thrombosis, and pulmonary embolism, 2.0 to 3.0. For a mechanical mitral valve, 2.5 to 3.5, and the same for some mechanical aortic valves with added risk, such as atrial fibrillation, a past clot, or an older valve type. Write the range the prescriber set, and the reason when it differs from 2.0 to 3.0.
Every 2 or 3 days when warfarin starts, until two results are in range. Then about weekly, stretching to every 2 weeks and then every 4 weeks once the dose is steady. Some patients who have been steady for a long time are tested less often, where your protocol allows. Check again within about a week of any dose change, and within 3 to 5 days of starting an interacting medicine such as an antibiotic.
The Rosendaal method draws a straight line between each pair of INR results, gives every day between them an estimated INR, and counts the share of days in range. In the atrial fibrillation example, about 149 of 161 days fall in range: a TTR of 92%. Many guidelines treat 70% or more as good control. Below about 65%, look for causes and review whether warfarin is still the best choice; a DOAC is not an option with a mechanical valve.
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The preventive visit: interval history, screening and vaccines due, full exam, and counseling.
The Medicare AWV, G0438 and G0439: health risk assessment, cognition, screening schedule, risk factors, and the prevention plan.
The one-time IPPE, G0402: history, depression and safety review, exam with visual acuity, end-of-life planning, and the written plan.
The standing summary at the front of the chart: problems, history, medications, allergies, immunizations, risks, and reminders, kept current.
Screening, vaccines, and counselling due at an adult periodic health review, by age and sex, with a next due date on every line.
INR calls, chronic disease reviews, and visit notes, drafted for you to check.
Catch new antibiotics and other interacting medicines before the next INR.
Notes for atrial fibrillation and valve follow-up, drafted from the visit.
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