ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

Appendix 17.2 Worksheet and Report Example

Patient Name: __________________________________ Patient ID#: Walk #: _______ Test Administrator: ______________ Date: Gender: M F Age: ___ Race: __ Height: ___________ inches____cm Weight: _______ lbs____kg Resting Blood pressure: Medications taken prior to test (dose and time): Supplemental O 2 during test: No Yes: ƒow _____________ L/min Delivery device: Baseline End of Test

Time Pulse rate Dyspnea score (Borg scale) Sp O 2 Stopped or paused before predetermined time: No Yes, reason Other symptoms at end of exercise: angina dizziness hip leg calf pain Comments: Interpretation:

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