Ecg
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Redoble Medical Clinic Buug, Zamboanga Sibugay
ELECTROCARDIOGRAPHIC REPORT
Name: __________________________ Age:_______Sex: __________Date___________________ Address: ____________________________________ BP:_____________ WT: _______________ Referring Physician: ______________________________________________________________ Clinical Data (Diagnosis/Medication): ________________________________________________ _________________________________________________________________________________ ECG FINDINGS Rhythm : ________________________________________________________________ Rate Atrial: __________________________ Vent _________________ Axis ___________ P Wave : ___________________________PR _________________________________ QRS : ___________________________ST Segment __________________________ T Wave : ___________________________ Others ______________________________ ECG Interpretation:
_____________________M.D
PATIENTS NAME:_____________________________________________________________
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
ELECTROCARDIOGRAPHIC REPORT
Name: __________________________ Age:_______Sex: __________Date___________________ Address: ____________________________________ BP:_____________ WT: _______________ Referring Physician: ______________________________________________________________ Clinical Data (Diagnosis/Medication): ________________________________________________ _________________________________________________________________________________ ECG FINDINGS Rhythm : ________________________________________________________________ Rate Atrial: __________________________ Vent _________________ Axis ___________ P Wave : ___________________________PR _________________________________ QRS : ___________________________ST Segment __________________________ T Wave : ___________________________ Others ______________________________ ECG Interpretation:
_____________________M.D
PATIENTS NAME:_____________________________________________________________
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
