Aufnahmetechnik: ___________________________________________________________________

P: _______ sek • PQ: _______ sek • QRS: _______ sek • QTm: _______ sek • QTc: _______ sek

R-Frequenz: _______ /min • P-Frequenz: _______ /min

Lagetyp: __________ • Übergangszone: __________

P-Welle / PQ-Strecke: _________________________________________________________________

QRS-Komplex: ______________________________________________________________________

ST-Strecke: ________________________________________________________________________

T-Welle / U-Welle: ___________________________________________________________________

Rhythmus: _________________________________________________________________________

Besonderheiten: ____________________________________________________________________

Gesamtbeurteilung: _________________________________________________________________

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