"Blood Pressure Home Monitoring Log"

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Westfield Family Physicians
Blood Pressure Home Monitoring Log
Name ___________________________________________________
BP Goal_________________________________
Day
200
190
180
Systolic
(top number)
170
160
150
140
135
130
125
120
115
110
105
100
Diastolic
110
(bottom number)
100
95
90
85
80
75
70
65
60
55
Check your blood pressure daily, or as often as requested by your provider. Your blood pressure goal is noted at the top of this page.
It is not unusual to have an occasional reading out of range, but if you are consistently getting readings 20 or more points above
your target, please notify our office. Please bring this sheet to your next appointment.
Westfield Family Physicians
Blood Pressure Home Monitoring Log
Name ___________________________________________________
BP Goal_________________________________
Day
200
190
180
Systolic
(top number)
170
160
150
140
135
130
125
120
115
110
105
100
Diastolic
110
(bottom number)
100
95
90
85
80
75
70
65
60
55
Check your blood pressure daily, or as often as requested by your provider. Your blood pressure goal is noted at the top of this page.
It is not unusual to have an occasional reading out of range, but if you are consistently getting readings 20 or more points above
your target, please notify our office. Please bring this sheet to your next appointment.