Blood Pressure Log printable pdf download

Blood Pressure Log

Patient Name _____________________________

Instructions: Please take blood pressure daily in the left arm, unless otherwise instructed.

Prior to taking, please sit quietly for 5 minutes. Please record both the systolic reading

(top number), the diastolic reading (bottom or lower number), and the pulse. Do not

repeat measurements unless there is an “error” message. Call if systolic blood pressure is

> 170 x three readings or diastolic is >100 for 3 readings. Call immediately for any

systolic reading >200 or diastolic reading >120. Please average every ten readings. Fax

results to 212-230-1359 when requested log period is completed or bring this sheet to you

at the next appointment. Your blood pressure machine should be brought to the office

once a year to be checked for accuracy.

Date/time

symptoms

Systolic BP

Diastolic BP

Pulse (HR)

AVERAGE

-------------------------

AVERAGE

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Blood Pressure Log