ATS Pulmonary Function Laboratory Manual

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

Appendix 18.2 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, „ow _____________ L/min Delivery device: Baseline End of Test

Time Pulse rate Dyspnea score (Borg scale) Sp O 2

Stopped or paused before 6 minutes: No Yes, reason Other symptoms at end of exercise: angina dizziness hip leg calf pain Number of laps: (X meters/feet) = ______________ Final partial lap: _______________ meters/feet Total distance walked in 6 minutes: ______________ meters or feet Comments: Interpretation: Sp O 2 nadir (lowest point): _____________

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