1. Time
Item
1. Time
time
2. Height
Item
2. Height
float
Height
Item
Height: Not Done
boolean
3. Weight
Item
3. Weight
float
Weight
Item
Weight: Not Done
boolean
4. Heart Rate
Item
4. Heart Rate
integer
Heart Rate
Item
Heart Rate: Not Done
boolean
5. Blood pressure
Item
5. Blood pressure: systolic
integer
Blood pressure
Item
Blood pressure: diastolic
integer
Blood pressure
Item
Blood pressure: Not Done
boolean
Item
5.a BP Position
text
Code List
5.a BP Position
6. Temperature
Item
6. Temperature
float
Temperature
Item
Temperature: Not Done
boolean
CL Item
Other (specify) (3)
Source
Item
If Other, please specify
text
7. Respiratory Rate
Item
7. Respiratory Rate: ___/min
integer
Respiratory Rate
Item
Respiratory Rate: Not Done
boolean
Completed by (initials)
Item
Completed by (initials)
text
Date completed
Item
Date completed
date