Six-Minute Walk Test Documentation

Clinical form to document six-minute walk test results, including distance walked, rest breaks, vital signs, oxygen saturation, symptoms, and test completion details.

Test Details

• Test Date
• Test Time
• Test Location
• Performed By
• Protocol Used

Pre-Test Baseline

• Baseline Heart Rate (bpm)
• Baseline Systolic Blood Pressure (mmHg)
• Baseline Diastolic Blood Pressure (mmHg)
• Baseline Oxygen Saturation (%)
• Baseline Symptoms

Walk Performance

• Distance Walked
  Enter the total distance walked during the six-minute test.
• Distance Unit
• Were any rest breaks taken?
• Number of Rest Breaks
• Was the test interrupted or stopped early?
• Reason for Interruption

During and Post-Test Vitals

• Lowest Oxygen Saturation During Test (%)
• Post-Test Heart Rate (bpm)
• Post-Test Systolic Blood Pressure (mmHg)
• Post-Test Diastolic Blood Pressure (mmHg)
• Post-Test Oxygen Saturation (%)

Symptoms, Notes, and Follow-Up

• Symptoms Observed During or After Test
• Did an adverse event occur?
• Adverse Event Details
• Additional Notes
• I confirm this documentation is accurate and complete to the best of my knowledge.