Respiratory function report 

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Date: 

Patient: 

DOB: 

Sex: 

Weight (kg): 

Height (cm): 

      Reading one        Reading two     Reading three Pre-ventolin Pre% reference 
FVC                 
FEV1                 
PEF                 
FEV1%                 
FEF2575               

    AIM Health Medical Center  

     Reading one   Reading two  Reading three Post-ventolin Post% reference Post %change 
FVC                  
FEV1                  
PEF                  
FEV1%                  
FEF2575                

Note: bronchodilator (2 puff Ventolin) was given. 

Comments:   

Test performed by registered nurse:  

Signature:  

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