Province of Ilocos Sur

ILOCOS SUR COMMUNITY COLLEGE

Vigan City
Health Science Department
Record of Blood Pressure Assessment
Name: ____________________________________________ Section: ___________________________________________

Full Name of Client Age Address and Contact Date and Time Blood Pressure Reading Signature of Remarks or Suggestions
Number Performed Client
Full Name of Client Age Address and Contact Date and Time Blood Pressure Reading Signature of Remarks or Suggestions
Number Performed Client
 Province of Ilocos Sur
ILOCOS SUR COMMUNITY COLLEGE
Vigan City
Health Science Department
Record of Temperature Assessment
Name: ____________________________________________ Section: ___________________________________________

Full Name of Client Age Address and Contact Date and Time Temperature / Site Signature of Remarks or Suggestions
Number Performed Convert OC to OF Client
Full Name of Client Age Address and Contact Date and Time Temperature / Site Signature of Remarks or Suggestions
Number Performed Convert OC to OF Client
 Province of Ilocos Sur
ILOCOS SUR COMMUNITY COLLEGE
Vigan City
Health Science Department
Record of Pulse Rate Assessment
Name: ____________________________________________ Section: ___________________________________________

Full Name of Client Age Address and Contact Date and Time Pulse Rate / Site Signature of Remarks or
Number Performed Client Suggestions

 You are required to assess 5 Apical, 5 radial, 5 brachial and 5 carotid pulses.
 Full Name of Client Age Address and Contact Date and Time Pulse Rate / Site Signature of Remarks or Suggestions
Number Performed Client

 You are required to assess 5 Apical, 5 radial, 5 brachial and 5 carotid pulses.
 Province of Ilocos Sur
ILOCOS SUR COMMUNITY COLLEGE
Vigan City
Health Science Department
Record of Respiratory Rate Assessment
Name: ____________________________________________ Section: ___________________________________________

Full Name of Client Age Address and Contact Date and Time Respiratory Rate Signature of Remarks or Suggestions
Number Performed Client
Full Name of Client Age Address and Contact Date and Time Respiratory Rate Signature of Remarks or Suggestions
Number Performed Client