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Data Collection Tool

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Please fill in the fields below to submit your monthly Blood Pressure data. If you have any questions about data entry, do not hesitate to contact Pat Schwegmann or Joan Adams at (859) 301-6333.

CARE Collaborating Partner:
Time Period/Date:
# of Patients Seen:
# of New BP Cards Used:
# of New Patients Who Cannot Properly Identify BP range:
# of New Patients in Yellow Range:
# of New Patients in Red Range:
# of Male BP Taken:
# of Patients Taking BP Medication:
# of Patients Returning With Cards:
# of Patients Returning without Card, New Card Given:
# of Returning Patients with improved BP now in the Green Zone:
# of Returning Patients with improved BP (still within the Red or Yellow Zone):
# of Patients who had improved BP who were started on medication:
# of Patients Taking Action (exercise, diet, smoking cessation, stress management, etc.), excludes medications:
# of Referrals Made To Primary Care Physician:
# Patients that have been told they have heart disease:
# Patients that have been told they have diabetes:
# of referrals made to the KY Quit Smoking Line:

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