| PE-1 | Blood pressure | __ __ __ mmHg |
| PE-2 | Pulse (bpm) | __ __ __bpm |
| PE-3 | Respiratory rate | __ __ __cpm |
| PE-4 | Temperature | __ __ __˚C |
| PE-5 | SpO2 | __ __ __ % |
| PE-6 | Weight | __ __ __ kg |
| PE-7 | Height | __ __ __ cm |
| PE-8 | BMI | __ __ __ kg∙m−2 |
| PE-9 | Mid abdominal circumference | __ __ __ cm |
| PE-10 | TIME TO GET UP AND Go | __ __ __ s |