Name: _____________________________________________________
My Target Blood Pressure is: ___________________________________
I am to call my healthcare practitioner:
if my blood pressure goes above ________ or falls below ________.
if I have the following symptoms: ____________________________
D
T
_______ ______
ATE
IME
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
_______ ______
B
P
LOOD
RESSURE
B
P
____________ ____________________________
LOOD
RESSURE
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
L
20
OG
C
OMMENTS