Fillable 7-DAY RECORDING LOG

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7-DAY RECORDING LOG

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Before you get started
Self-measured blood pressure (SMBP) monitoring works best when
you partner with your health care professional (HCP).
• Review the technique for measuring your BP properly with your
care team.
• Every year, ask your HCP’s oce to check that your device is
working properly.
• Determine your BP monitoring plan with your HCP and ll out this
section together so you know your plan.
• My BP goal is ______________
For most people, measuring twice in the morning and twice in the evening
for one week gives the best information about their BP.
• I will use my: n right arm n left arm
The first time you check your BP, check it in both arms. Use the arm
with the higher reading for future measurements.
• I will call my HCP’s office if I experience these symptoms:
_____________________________________________
• I will also call my HCP’s office if my BP is less than ______ or
higher than ______.
If your BP is too high or too low, wait 5 minutes and then re-check it.
If it is still too high or too low, call your HCP.
• I will send my BP log to my HCP by: n phone n email
n patient portal message n mail n fax
Instructions for EACH TIME you measure your BP
1. Review the “Measuring BP Accurately” graphic to ensure
proper BP measurement technique.
2. Take your BP at the same time each day in the morning
and the evening.
3. Record your BP readings daily using this log.
4. Fill out the Notes Section with the following:
• Did you take your medicine?
• Your mood (anxious, stressed, joyful, etc.)
• Feelings (lightheaded, headache, , etc.)
© 2020 American Medical Association. All rights reserved. 20-446936:PDF:5/20
SELF-MEASURED BLOOD PRESSURE:
7-DAY RECORDING LOG
DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7
Morning
Notes
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
SYS
SYS
SYS
SYS
DIA
DIA
DIA
DIA
PULSE
PULSE
PULSE
PULSE
1
2
Notes
1
2
Evening
Morning
Notes
1
2
Notes
1
2
Evening
Morning
Notes
1
2
Notes
1
2
Evening
Morning
Notes
1
2
Notes
1
2
Evening
Morning
Notes
1
2
Notes
1
2
Evening
Morning
Notes
1
2
Notes
1
2
Evening
Morning
Notes
1
2
Notes
1
2
Evening
(Date) (Date) (Date) (Date) (Date) (Date) (Date)
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7-DAY RECORDING LOG

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Completed 8 June 2022

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