10 | Arcus senilis Yes = 1, No = 2 |
11 | BP (Systolic/diastolic, mmHg) SBP1 DBP1 SBP2 DBP2 SBP3 DBP3 |
12 | JVP JVP Normal Yes = 1, No = 2 JVP Height (cm) a wave form Normal = 1, Absent = 2, Large = 3 v wave form Normal = 1, Giant = 2 |
13 | Apical impulses: Character of apical impulse 1 = Normal, 2 = Sustained heaving, 3 = Tapping, 4 = Heaving/diffuse (thrusting), 5 = Feeble, 6 = Absent, 7 = Other If other, specify Location of apical impulse 1 = Normal, 2 = Ant. Axillary line, 3 = Axilla, 4 = Other If other, specify Specify interspace |
14 | Heart rate (beats/Min) |
15 | Heart rhythm 1 = Regular, 2 = Occasional premature beats, 3 = Frequent premature beats, 4 = Atrial fibrillation, 5 = Gallop, 6 = Other |
16 | If other, specify heart rhythm |
17 | Heart sounds 1 = Normal, 2 = Distant, 3 = Not heard, 4 = Abnormal A2 1 = Normal, 2 = Accentuated, 3 = Diminished/absent P2 1 = Normal, 2 = Accentuated, 3 = Diminished/absent M1 1 = Normal, 2 = Accentuated, 3 = Diminished/absent Other Yes = 1, No = 2 If other is yes, specify other |
18 | Murmurs/thrills None Yes = 1, No = 2 Aortic systolic Yes = 1, No = 2 Apical systolic Yes = 1, No = 2 Pulm systolic Yes = 1, No = 2 Aortic diastolic Yes = 1, No = 2 Apical diastolic Yes = 1, No = 2 Pulm diastolic Yes = 1, No = 2 Other specify |
19 | Respiratory findings: Normal respiratory finding? Yes = 1, No = 2 If no, specify abnormality |
20 | Abdomen Normal Yes = 1, No = 2 Specify if no |
21 | Attending diagnosis? Yes = 1, No = 2 Specify if yes |