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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:
New Participants/Patients
  BP cards given
  Could not identify BP category
  Patients in Green Category
  Patients in Yellow Category
  Patients in Red Category
Returning Particpants/Patients
  With cards
  Without card, new card given
  Could not identify BP category
  No improvement Patient still in Green Category
  Patient improved TO the Green Category
  No improvement Patient still in Red or Yellow Category
  Patient improved but still in Red or Yellow Category
  Improved BP who started medication
  Patients making lifestyle changes
Patient Referrals
  Primary care physician/clinic
  Quit line
Medical History
  Patients taking BP medication
  Use tobacco
  Heart disease

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