Get Annexure Ii - 2 Computerised Treadmill Test Form No ...

Filling out the ANNEXURE II - 2 COMPUTERISED TREADMILL TEST Form No. LIC03 - 003 online is a straightforward process that requires careful attention to detail. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by providing information regarding the patient's medical history. Answer the questions about chest pain, heart disease, and previous tests truthfully by selecting 'Yes' or 'No'. If 'Yes' is selected for any question, ensure to submit relevant medical documents with the form.
3. Fill out the pre-test section. Document the conditions under which the treadmill test will be conducted, including the supine position and any hyperventilation requirements.
4. Record data for each exercise stage. Include detailed observations for Supine, Sitting, Standing, and Hyperventilation positions, along with WARM UP and each of the peak exercise stages (Stage I, Stage II, Stage III). Be sure to indicate the time spent in each stage, speed in miles per hour, grade percentage, workload in METS, heart rate in beats per minute, blood pressure, and RPP.
5. Complete the reporting pattern section. Fill in the name of the individual undergoing the test, their age and sex, and the phase names corresponding to pre-test, exercise, and recovery.
6. At the end of the form, document the maximum blood pressure, maximum workload, maximum heart rate, and maximum predicted heart rate. Indicate the reason for termination of the test and add any additional comments as necessary.
7. Provide the cardiologist’s signature to validate the results of the test. Ensure that each test stage has a 12-lead tracing recorded individually with relevant observations noted.
8. Once all sections are adequately filled, review the form for any inaccuracies. Save any changes, then download, print, or share the completed form as needed.

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