HEALTH STATUS / VITAL SIGNS Height: Height: Weight: (Feet) (Inches) (Pounds) BMI Calculator Waist Circumference: Body Mass Index: Temperature: (In) (BMI) (Degrees) Temperature Method: Axillary Ear Oral Rectal Temporal      Pulse: Pulse Method: (Beats / Minute) Pulse Description:   Weak  Irregular  Bounding Respiration (Breaths / Minute) Shallow Respiration Description: 02 Saturation:    Wheezing (%) Blood Pressure Position #1: Lying Sitting Standing Blood Pressure #1:    Blood Pressure #2: Blood Pressure Position #2: Lying Sitting Standing    Blood Pressure #3: Blood Pressure Position #3: Lying Sitting Standing    Vital Signs Comments: (Indicate where on body blood pressure was taken each time). Appearance Hair Color:  Bald  Black  Blonde Brown / Gray Red /    Shaved Other   (specify) Hair Comments: Eye Color:  Blue  Brown  Gray  Other Green Hazel   Eye Comments: General Appearance: Adequate oral care Clothing inappropriate to season Neat    Appears older than stated Disheveled Poor grooming     Appears stated age  Excessive / Inappropriate make-up  Poor oral care Appears younger than stated age Malodorous Other    (specify) Clean  2
HEALTH STATUS / VITAL SIGNS Height: (Feet) Height: (Inches) Weight: (Pounds) Waist Circumference: (In) Body Mass Index: (BMI) BMI Calculator Temperature: (Degrees) Temperature Method:  Axillary  Ear  Oral  Rectal  Temporal Pulse: (Beats / Minute) Pulse Method: Pulse Description:   Weak  Irregular  Bounding Respiration (Breaths / Minute) Respiration Description:   Shallow  Wheezing 02 Saturation: (%) Blood Pressure #1: Blood Pressure Position #1:  Lying  Sitting  Standing Blood Pressure #2: Blood Pressure Position #2:  Lying  Sitting  Standing Blood Pressure #3: Blood Pressure Position #3:  Lying  Sitting  Standing Vital Signs Comments: (Indicate where on body blood pressure was taken each time). Appearance Hair Color:  Bald  Brown /  Shaved  Black  Gray  Other (specify)  Blonde  Red / Hair Comments: Eye Color:  Blue  Green  Brown  Hazel  Gray  Other Eye Comments: General Appearance:  Adequate oral care  Appears older than stated  Appears stated age  Appears younger than stated age  Clean  Clothing inappropriate to season  Disheveled  Excessive / Inappropriate make-up  Malodorous  Neat  Poor grooming  Poor oral care  Other (specify) 2
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