ECG Acquisition and Interpretation Note

Patient: [Full name] — MRN: [Medical record number]

ECG Date/Time: [Date and time of acquisition]

Interpretation Date/Time: [Date and time of interpretation, or "Same as acquisition"]

ECG Type: [12-lead ECG / 12-lead ECG with posterior leads V7–V9 / 12-lead ECG with right-sided leads / 12-lead ECG with posterior and right-sided leads]

ECG Instance: [Initial / Repeat #__ / Post-intervention / Post-medication / Pre-procedure]

Acquired By: [Interpreting clinician / Nursing / ECG technician / EMS / Other]

Interpreting Clinician: [Name, credentials]

Clinical Context

Indication: [Indication for ECG] (If unknown, document "Indication unknown" rather than inferring.)

Symptom Status at Acquisition: [Symptom timing and whether present or resolved at time of ECG]

Pertinent Baseline Factors: [Known pacemaker/ICD, known bundle branch block, relevant medications given immediately prior, or "None"] (Include only if materially affects interpretation.)

ECG Interpretation

(For normal or near-normal ECGs, a concise summary sentence is acceptable. For abnormal findings, provide specific quantitative and localized details. Do not leave findings blank—state normal, abnormal with details, or not assessed with reason.)

• Quality: [Adequate / Limited: specify issue]
• Rate: [Ventricular rate] bpm; Atrial [rate if different, or "same"]
• Rhythm: [Named rhythm] (If uncertain, state why.)
• Intervals: PR [ms or "not applicable: reason"]; QRS [ms]; QT [ms]; QTc [ms] [measured / machine-calculated]
• Axis: [Normal / Left / Right / Extreme] [numeric degrees if available]
• Conduction: [Normal / LBBB / RBBB / IVCD / AV block (degree) / Paced / Pre-excitation / Other]
• Morphology: [LVH pattern / RVH pattern / Pathologic Q waves (leads) / Abnormal R-wave progression / None relevant]
• ST-T Changes: [No ST-T abnormalities / ST elevation: mm in leads, reciprocal changes / ST depression: mm in leads / T-wave inversions in leads / Hyperacute T waves / Non-ischemic pattern: specify]
• Ectopy: [None / PACs / PVCs / Couplets / Runs: describe]
• Computer Interpretation: [Reviewed and agree / Reviewed and disagree: reason / Not displayed] (Do not substitute machine text for clinician interpretation.)

Comparison

[No prior ECG available for comparison / Compared with ECG dated [date]: findings are new / unchanged / resolved / worsened—specify relevant changes]

Impression

[One to three sentence synthesis classifying the ECG as normal, abnormal with specified findings, or nondiagnostic. For high-risk patterns, state plainly. If nondiagnostic but clinical concern persists, note that ECG does not exclude the condition.] (This section is mandatory and must contain more than a single word.)

Actions and Plan

(Include when ECG findings are abnormal or drove clinical decisions; omit for normal ECGs that did not change management.)

• Immediate Actions: [Actions taken due to ECG findings: escalation, cath lab activation, consultation, medications]
• Next Steps: [Serial ECG timing/triggers, additional leads to obtain, labs or imaging prompted by findings]

Communication

(Include only when concerning or critical findings were communicated; omit for normal/nonurgent ECGs.)

Communicated: [Finding communicated] to [Name, role] on [Date/time] via [phone / in-person / secure message]

Signature: [Clinician name, credentials] — [Date/time]