You can always press Enter⏎ to continue
Current Vitals
Hi there, please fill out and submit this form.
10
Questions
START
1
Full Legal Name:
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Date of Birth
-
Date
Year
Month
Day
Previous
Next
Submit
Press
Enter
3
Who is your Respiratory Therapist?
Alexander Grichuhin, RRT-RCP
Melanie Klein, RRT-RCP
Channon Harper, CRT-RCP
Milly Castillo, RCP
Alexander Grichuhin, RRT-RCP
Alexander Grichuhin, RRT-RCP
Melanie Klein, RRT-RCP
Channon Harper, CRT-RCP
Milly Castillo, RCP
Previous
Next
Submit
Press
Enter
4
Enter your Blood Pressure (120/70):
Previous
Next
Submit
Press
Enter
5
BORG (How out of breath do you feel 10 being worst, 0 is least)
10
9
8
7
6
5
4
3
2
1
0
10
9
8
7
6
5
4
3
2
1
0
Previous
Next
Submit
Press
Enter
6
How many Liters of oxygen are you using today (If none just leave blank)?
Previous
Next
Submit
Press
Enter
7
Please rate your pain, 10 is the worst, 0 is the least.
10
9
8
7
6
5
4
3
2
1
0
10
9
8
7
6
5
4
3
2
1
0
Previous
Next
Submit
Press
Enter
8
Oxygen readings on your pulse oximeter (After 30 seconds):
*
This field is required.
Previous
Next
Submit
Press
Enter
9
Pulse Rate (Found on your pulse oximeter):
*
This field is required.
Previous
Next
Submit
Press
Enter
10
Can you participate in therapy today?
*
This field is required.
YES
NO (if NO, Please excuse yourself from class & let your assigned clinician know)
YES
NO (if NO, Please excuse yourself from class & let your assigned clinician know)
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
10
See All
Go Back
Submit