Healthcare Questionnaire

Please complete this questionnaire to help us provide better care

Vital signs, weight, height, head circumference, oximetry, BMI, & BSA panel

Please enter your current vital signs measurements

SaO2 % BldC Oximetry

Weight Measured

Head Circumf OFC by Tape measure

Bdy height

Body temperature

Cel

BP dias

mm[Hg]

BP sys

mm[Hg]

Heart rate

{beats}/min

Resp rate

{breaths}/min

BSA Derived

BMI(Calculated)

kg/m2