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2012
March
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Enter your blood pressure reading
Enter your weight
Enter your Pulse(# of beats during one minute)
Are you coughing more than usual?
Yes
No
Have you noticed more swelling in your feet, legs, hands, or belly than usual?
Yes
No
Did you have to sleep sitting up or propped up with more pillows than usual?
Yes
No
Have you felt more tired than usual doing everyday activites?
Yes
No
Do you feel your heartbeat racing or like you might pass out?
Yes
No
Does your belly feel full or bloated?
Yes
No
Have you lost your appetite or feel like you might throw up?
Yes
No
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