RECORDING MEASUREMENT FORM - Prometric
[Pages:5]RECORDING MEASUREMENT FORM
Resident's Name: (Do not need to complete for test) Date: (Do not need to complete for test)
Record Respirations
____________________/minute
______________________________________
Candidate's Signature
RECORDING MEASUREMENT FORM
Resident's Name: (Do not need to complete for test) Date: (Do not need to complete for test)
Record Pulse
____________________/minute
______________________________________
Candidate's Signature
INTAKE AND OUTPUT FORM (I&O)
(Not Required for Wyoming)
Resident's Name: (Do not need to complete for test) Date: (Do not need to complete for test)
Time
Intake
Type (oral, IV or Tube Feeding)
Amount in ml (or cc's)
Initials
Time
Output
Type (Urine, emesis or diarrhea)
Amount in ml (or cc's)
Initials
________________________________________
Candidate's Signature
FOOD AND FLUID INTAKE FORM
Resident's Name: (Do not need to complete for test) Date: (Do not need to complete for test)
Intake Check one: Meal Snack
Amount of Food Eaten Check one: 0% 25% 50% 75% 100%
Amount of Fluid Intake Check one: 0% 25% 50% 75% 100%
________________________________________
Candidate's Signature
RECORDING MEASUREMENT FORM (Florida Only)
Resident's Name: (Do not need to complete for test) Date: (Do not need to complete for test)
Record Pulse
1st Measurement
/minute
2nd Measurement
/minute
________________________________________
Candidate's Signature
................
................
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