| Question | Response |
|---|---|
| Date Performed | |
| Subject position | Sitting Standing Supine |
| PR Interval (msecs) | |
| QRS Interval (msecs) | |
| QT Interval (msecs) | |
| QTc Interval (msecs) | |
| Heart Rate (cycle/min) | |
| ECG Result Interpretation | Normal Abnormal Not Clinically Significant Abnormal Clinically Significant |
| Specify ECG Abnormality Result |