Get Six Minute Walk Test Form 2011-2025

The Six Minute Walk Test Form is an essential tool for assessing lung function and gathering important data during clinical evaluations. This guide provides clear, step-by-step instructions for users on how to fill out the form online, ensuring a smooth and efficient process.

Follow the steps to complete the Six Minute Walk Test Form online

1. Press the ‘Get Form’ button to access the Six Minute Walk Test Form and open it in your preferred online editor.
2. Begin by entering the header information. Record the form date in the mm/dd/yyyy format, using the provided calendar or by typing it in.
3. Record your initials in the space provided for the staff code. If you do not have a code, contact the GIC for assistance.
4. Address Item 1 regarding medications taken since post-bronchodilator spirometry. Enter 'Y' for Yes or 'N' for No. If Yes, complete the additional fields for medication name, dose, and time.
5. For Item 2, indicate whether blood pressure was recorded more than 4 hours prior to the test by selecting 'Y' or 'N.' If Yes, fill in the systolic and diastolic pressures.
6. In Item 3, denote if supplemental oxygen was used during the test by writing 'Y' or 'N.' If Yes, provide the oxygen flow rate and type.
7. Item 4 requires recording SpO2 at rest prior to the test and the user's pulse as beats per minute.
8. In Item 5, indicate whether continuous oximetry was recorded with 'Y' for Yes or 'N' for No.
9. Item 6 calls for the start time of the six-minute walk; enter the precise time in hours and minutes, selecting AM or PM.
10. After the six-minute walk, fill in Item 7 with SpO2, pulse, breathlessness (on the Modified Borg Scale), and exertion (on the Borg Scale of Perceived Exertion).
11. For Item 8, select the type of course used and record the number of completed laps as well as the distance walked in the final partial lap.
12. In Item 9, if the participant stopped before six minutes, note 'Y' for Yes or 'N' for No and address the subsequent questions regarding duration and reasoning.
13. Lastly, once all the fields are completed, ensure that the data is reviewed and then saved. You can download, print, or share the form as needed.

Start filling out the Six Minute Walk Test Form online today!