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
____________ ____________________________
B
P
LOOD
RESSURE
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
_____ / _ _____ ____________________________
RESSURE
21
40
L
OG
C
OMMENTS