Record of Experience: Evidence for Performing and Reporting Static Lung Volume Measurements Using
(please indicate method)
 Ensure patient identification is physically removed
 Ensure each entry is accompanied by an acceptable quality printed raw data set performed to ARTP standards
 Each data set must be presented with accompanying interpretation form displayed in sequence to permit easy visual comparison
Key
Date
Date the static lung volumes were recorded by the student
Indication
Reason for performing static lung volume measurement
Age
Age of the patient
Category
This is your initial interpretation of the results.
Date
1
2
3
4
5
6
7
8
9
10
Indication
Age
Category
Mentor
Signature
Patient Results
Male or female
Height (cm)
Indication for Static Lung
Volumes
Type of ward or department
e.g. surgical, outpatient
Weight (Kg)
Smoking Pack Year History
BMI
Age of patient
Static Lung Volume Results
Actual
Percentage
Predicted
RV (L)
Predicted
Lower
FRC (L)
TLC (L)
ERV (L)
IC (L)
Interpretation of Results and Reflection on Test Quality
Predicted
Mean
Predicted
Upper
RSD
SR