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AMBULATORY BLOOD PRESSURE MONITORING
PATIENT DIARY
Name:
Date of birth:
Monitoring date:
8:00-8:30 20:00-20:30
8:30-9:00 20:30-21:00
9:00-9:30 21:00-21:30
9:30-10:00 21:30-22:00
10:00-10:30 22:00-22:30
10:30-11:00 22:30-23:00
11:00-11:30 23:00-23:30
11:30-12:00 23:30-24:00
12:00-12:30 0:00-0:30
12:30-13:00 0:30-1:00
13:00-13:30 1:00-1:30
13:30-14:00 1:30-2:00
14:00-14:30 2:00-2:30
14:30-15:00 2:30-3:00
15:00-15:30 3:00-3:30
15:30-16:00 3:30-4:00
16:00-16:30 4:00-4:30
16:30-17:00 4:30-5:00
17:00-17:30 5:00-5:30
17:30-18:00 5:30-6:00
18:00-18:30 6:00-6:30
18:30-19:00 6:30-7:00
19:00-19:30 7:00-7:30
19:30-20:00 7:30-8:00
Complete the activity diary during the monitoring session using the numbered guide as
shown below to reduce your work. Careful completion will help the physician evaluate
the data recorded. Do not forget to record the time you awake and go to sleep.
1 = Working 2 = Housework (what kind) 3 = Walking
4 = Exercise (what kind) 5 = Driving 6 = Travelling
7 = Eating 8 = Watching TV 9 = Relaxing
10 = Sleeping
Medication taken during the measurement:push the button marked with heart.
1.
2.
3.
4.
5.
IM_EN.indd 26 19/07/2012 14:30:03