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pdf Blood Pressure
Examiner Code
4. Extremity: (check one)
1
Right arm (preferred)
2
Left arm
5. Cuff size: (check one)
1
Infant
2
Child/Small Adult
3
Adult
4
6. Pulse Disappearance Pressure:
Lg. Arm
5
Thigh
mm. Hg
+30
7. Maximum inflation level (MIL):
mm. Hg
8. Blood Pressures:
Systolic
Diastolic
1st BP
mm. Hg.
2nd BP
mm. Hg.
3rd BP
mm. Hg.
8a. If unable to measure blood pressure, check reason:
1
Patient refused
1
Unable to determine MIL
1
Patient unable to sit
1
Unable to hear blood pressure sounds
1
Radial pulse not felt in either arm
1
Equipment malfunction
1
No cuff appropriate size
Acanthosis Nigricans
Examiner Code
9. Is Acanthosis Nigricans: (check one)
1
Yes
2
No
3
Maybe
FOR STUDY USE ONLY
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SEARCH 3 Registry Study Physical Exam form - 11-01-10
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| File Type | application/pdf |
| File Title | Microsoft Word - Physical_Examination_Form_9-13-10 Registry and Cohort 11-01-10 FINAL FINAL FINAL |
| Author | stmoxley |
| File Modified | 2011-05-10 |
| File Created | 2010-10-30 |