Date: -Time: -

Observation Item

Systolic

mmHg

-

Diastolic

-

Temp

°C

-

SpO2

-

MAP

-

Pulse

-

Weight

-

Kg.

Height

-

Cm.

BMI

-

kg/m2

Respirations

-

br/min

Head

Circumference

Cm.

-

Chest

Circumference

Cm.

-

Wist

Circumference

Cm.

-

Neck

Circumference

Cm.

-

Patient Info

EN:

First Name:

-

Last Name:

-

Date of Birth: -

Staff ID: