Respondent sequence number
Blood Pressure Status
Blood Pressure Time in Seconds
Blood Pressure Comment
60 sec HR (30 sec HR * 2)
Had food in the past 30 minutes?
Had alcohol in the past 30 minutes?
Had coffee in the past 30 minutes?
Had cigarettes in the past 30 minutes?
Arm selected:
Coded cuff size
60 sec. pulse (30 sec. pulse * 2):
# of dropped beats in 30 seconds
Pulse regular or irregular?
Pulse type:
MIL: maximum inflation levels (mm Hg)
Systolic: Blood pres (1st rdg) mm Hg
Diastolic: Blood pres (1st rdg) mm Hg
Enhancement used first reading
Systolic: Blood pres (2nd rdg) mm Hg
Diastolic: Blood pres (2nd rdg) mm Hg
Enhancement used second reading
Systolic: Blood pres (3rd rdg) mm Hg
Diastolic: Blood pres (3rd rdg) mm Hg
Enhancement used third reading
Systolic: Blood pres (4th rdg) mm Hg
Diastolic: Blood pres (4th rdg) mm Hg
Enhancement used fourth reading
SBP average reported to examinee
DBP average reported to examinee