Vital Sign/Blood Pressure
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Detailed Instructions
Measure your blood pressure as discussed with Provider Musgrave. If instructed to take for multiple days; then take at almost the same times every day.
Before taking a measurement, a you need to sit comfortably with both feet on the floor for at least two minutes.
For valid results, when taking a patient's blood pressure, place his or her arm on a table so that the blood pressure cuff is roughly the same height as the patient's heart.
Record the patient's blood pressure and fill out the form.
Date
*
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Patient's Full Name
*
First Name
Last Name
Blood Pressure Top number
*
Blood Pressure Bottom number
*
Heart Rate number
Weight
Type of BP Machine used
Home Machine
Reported from Another Provider Visit
Retail Store Machine
Other
If other explain here
Signature
*
Submit
Should be Empty: