Clinical Vital Signs Reader
Patient Demographic Information
Patient ID:
*
First Name:
*
Last Name:
*
Birth Date (mm/dd/yyyy):
*
Gender
*
Please Select
Male
Female
Measure Number:
Measure Date/Time:
Frequency (bpm):
Body Position:
Please Select
Standing
Sitting
Lying Down
Exertion:
Please Select
Resting
Exercising
Regularity:
Please Select
Pulse Irregular
Pulse Regular
Location:
Please Select
brachial artery
carotid artery
external carotid artery
dorsalis pedis artery
superficial femoral artery
popliteal artery
radial artery
subclavian artery
superficial temporal artery
tibial artery
posterior tibial artery
Rhythm
Please Select
bigeminal pulse
premature atrial contraction
heart irregular
palpitations
pulse regularly irregular
heart regular
trigeminal pulse
pulsus alternans
Submit Form
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