Name: ________________________________________
Date: _________________________________________
Procedure 56-1:
Objective: Accurately calculate adult body mass index following the steps in the procedure.
Equipment and Supplies: Patient’s record; paper and pen; scale for height and weight; BMI
formula or nomogram, or chart for BMI
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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Name: ________________________________________
Date: _________________________________________
POINT VALUE
= 3–6 points
= 7–9 points
TRIAL
# 1
TRIAL
# 2
NOTES
1. Perform hand hygiene.
2. Greet and identify the patient;
introduce yourself if you have not
3. If the recent height and weight
measurements are not available,
obtain the patient’s height and
weight.
4. Insert the patient’s height and
weight into the formula, using
pounds and inches or kilograms
and meters according to facility
policy.
a. Formula for pounds and inches:
BMI = Weight in pounds ÷
(Height in inches × Height in
inches) × 703
b. Example: Wt. 175 lbs; Ht 64
inches
175 ÷ (64 × 64) = 0.0427 × 703
= 30.0 BMI
5. Record results in the patient’s
record.
Points Earned
Points Possible 21 21
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
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signature
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