Preeclampsia Focused Exam Checklist
Use this form to document a focused preeclampsia exam, including patient context, key symptoms and findings, measurements, and follow-up actions.
Patient and exam context
Exam date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Patient initials or encounter identifier
*
Age
Gestational age (weeks)
*
Exam location / setting
*
Exam measurements and observations
Blood pressure reading (mmHg)
*
Urine protein result / urine dipstick
*
Please Select
Negative
Trace
1+
2+
3+
4+
Not done
Other
Weight (kg)
Weight change since last visit (kg)
Additional clinical observations
Disposition and follow-up
Assessment summary / impression
*
Immediate action taken and follow-up plan
*
Submit
Should be Empty: