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Vital Signs (for either Day 0, Day 11, or Both)

In association with the 6 Minute Walking Test, enter Vital Signs measurements here with this survey.
Or if you prefer, send a readable image of the Vital Signs form to Vitals@StudyLTCovid.com

Use as much of this survey as you need to enter results today. It allows for entry of results for BOTH Day 0 and Day 11. But if entering for only one of these two days, that's OK. Leave the others blank.

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* 1. Enter your assigned number for this study. As explained elsewhere, for those in the "Quick Impressions" group, it should be: QI- + initials (made up if you prefer) + year of birth. Mine looks like "QI-WJO-1950."

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* 2. Enter Today's Date (dd/ mm/ yyyy)

Date

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* 3. Select the Day of the study for which you are now providing Vital Signs

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* 4. Day 0: "Pre" or At Rest Vital Signs. Copy the format of this example:
"Pre" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels so:
Pre, 36.6, 130, 70, 64, 97 is acceptable.
But please keep them in that order to avoid confusion.

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* 5. Day 0: "0 Minute" Vital Signs (Done immediately after the 6 Minute Walking Test). Copy the format of this example:
"0 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels so, entered in order:
0, 36.6, 130, 70, 64, 97 is acceptable.

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* 6. Day 0: "5 Minute" Vital Signs.
Copy the format of this example:
"5 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels, but please enter in same order:
5, 36.6, 130, 70, 64, 97 is acceptable.

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* 7. Day 0: "10 Minute" Vital Signs. Copy the format of this example:
"10 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels, but please enter in order:
10, 36.6, 130, 70, 64, 97 is acceptable.

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* 8. Day 0: "15 Minute" Vital Signs. Copy the format of this example:
"15 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels, but please enter in order:
15, 36.6, 130, 70, 64, 97 is acceptable.

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* 9. Day 11: "Pre" Vital Signs. This is the At Rest measurement.
Copy the format of this example:
"Pre" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels, but please enter in order:
Pre, 36.6, 130, 70, 64, 97 is acceptable.

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* 10. Day 11: "0 Minute" Vital Signs (Done immediately after the 6 Minute Walking Test). Copy the format of this example:
"0 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels so, entered in order:
0, 36.6, 130, 70, 64, 97 is acceptable.

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* 11. Day 11: "5 Minute" Vital Signs.
Copy the format of this example:
"5 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels so, entered in order:
5, 36.6, 130, 70, 64, 97 is acceptable.

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* 12. Day 11: "10 Minutes" Vital Signs.
Copy the format of this example:
"10 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels so, entered in order:
10, 36.6, 130, 70, 64, 97 is acceptable.

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* 13. Day 11: "15 Minutes" Vital Signs.
Copy the format of this example:
"15 minutes" 36.6°C, BPs 130, BPd 70, Pulse 64, spO2 97%
Don't need the labels so, entered in order:
15, 36.6, 130, 70, 64, 97 is acceptable.

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* 14. Enter any notes, observations, comments or thoughts that you have in the space below. For example: How difficult was the Walking Test? Any problems with the equipment for taking Vital Signs?

Thank you for your answers. You may have just entered Day 0 values, or Day 11, or both. If only Day 0 or Day 11, you can use the same link to come back and enter values for the remaining Day. That will look like a new form, and not this one if partially completed today.
Remember to click the button below when done, to save your responses.
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