Blood Pressure Check Service

33%

Patient’s Details
RxWeb Patient Details*
Name, DOB, NHS#, Phone, Email, Address.
Email*
GP Surgery*
Please select your GP surgery
Please type the name of your GP surgery
Clinic BP Reading
Date
Date Format: DD slash MM slash YYYY
Systolic*
Diastolic*
Low Blood Pressure
Low BP - Symptoms Check*
Does the patient have side effects
- None
- Dizziness, nausea or fatigue
- Regular fainting or falls or feel like they may faint on a daily/near daily basis
Low - GP Notification - General*
- Patient Notification
- GP Notification
Low - GP Notification - 3 Week Appointment*
- Patient Notification
- 3 Week Appointment
Refer for SAME DAY GP appointment or A&E
Low - GP Notification - Same Day Appointment*
- Patient Notification
- Same Day Appointment
Normal Blood Pressure
Normal - GP Notification - General*
- Patient Notification
- GP Notification
V. High Blood Pressure
Refer for SAME DAY GP appointment or A&E
V. High - GP Notification - Same Day Appointment*
- Patient Notification
- Same Day Appointment
High Blood Pressure - Systolic
HBP - Systolic - ABPM Required*
- Yes
- Refused
High Blood Pressure - Diastolic
HBP - Diastolic - ABPM Required*
- Yes
- Refused
High Blood Pressure - Systolic + Diastolic
HBP - Systolic + Diastolic - ABPM Required*
- Yes
- Refused
ABPM Refused
HBP - ABPM Refused - GP Notification - 3 Week Appointment*
- Patient Notification
- 3 Week Appointment
Next Appointment
Next Appointment - Date
Next Appointment - Time
: HH
MM
Click the Save and Continue Later when appointment is booked

ABPM Results
Date ABPM device fitted
Date Format: MM slash DD slash YYYY
Average Day Time*
Average Night Time*
Average 24 hours - Systolic*
Average 24 hours - Diastolic*
ABPM Results
Drop files here or
ABPM Email Notifications
Normal ABPM - GP Notification - General*
- Patient Notification
- GP Notification
High ABPM - Systolic - GP Notification - 3 Week Appointment*
- Patient Notification
- 3 Week Appointment
High ABPM - Diastolic - GP Notification - 3 Week Appointment*
- Patient Notification
- 3 Week Appointment
High ABPM - Systolic + Diastolic - GP Notification - 3 Week Appointment*
- Patient Notification
- 3 Week Appointment
Refer for SAME DAY GP appointment or A&E
V. High ABPM - GP Notification - Same Day Appointment*
- Patient Notification
- Same Day Appointment

Consent
Consent*
- I agree to share my name, address and information about blood pressure readings with my GP practice so they can update my health record.
Comments
N/A
Email
This field is for validation purposes and should be left unchanged.

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Patient’s Details