Nursing Report Sheet Template (1)
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Patient Name:__________________________ Patient Room:_________ DOB:___________ Sex:__ Doctors: Diagnosis: Allergies: History: Code Status: VS: 0700 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________ 1200 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________ 1600 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________ Blood Sugars: 0700___________ 1200_________ 1700_____________2200______________ Med Pass: 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 0100 0200 0300 0400 0500 0600 Intake: Breakfast_____________Lunch_______________Supper_____________ ____ Other:________________ Output: Foley___________BM:________ Emesis_______Drains:_______ Tubes______ Ostomy Bag:___________ Labs:__________________________________________________Needed Labs:____________________________ Future Procedures:___________________________________________________________________________ ___ ************************************************ ********** Patient Name:__________________________ Patient Room:_________ DOB:___________ Sex:__ Doctors: Diagnosis: Allergies: History: Code Status: VS: 0700 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________ 1200 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________ 1600 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________ Blood Sugars: 0700___________ 1200_________ 1700_____________2200______________ Med Pass: 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 0100 0200 0300 0400 0500 0600 Intake: Breakfast_____________Lunch_______________Supper_____________ ____ Other:________________
description
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Transcript of Nursing Report Sheet Template (1)
Patient Name:__________________________ Patient Room:_________ DOB:___________ Sex:__
Doctors:
Diagnosis:
Allergies:
History:
Code Status:
VS: 0700 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
1200 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
1600 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
Blood Sugars: 0700___________ 1200_________ 1700_____________2200______________
Med Pass: 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 0100
0200 0300 0400 0500 0600
Intake: Breakfast_____________Lunch_______________Supper_____________ ____ Other:________________
Output: Foley___________BM:________ Emesis_______Drains:_______ Tubes______ Ostomy Bag:___________
Labs:__________________________________________________Needed Labs:____________________________
Future Procedures:______________________________________________________________________________
**********************************************************
Patient Name:__________________________ Patient Room:_________ DOB:___________ Sex:__
Doctors:
Diagnosis:
Allergies:
History:
Code Status:
VS: 0700 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
1200 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
1600 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
Blood Sugars: 0700___________ 1200_________ 1700_____________2200______________
Med Pass: 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 0100
0200 0300 0400 0500 0600
Intake: Breakfast_____________Lunch_______________Supper_____________ ____ Other:________________
Output: Foley___________BM:________ Emesis_______Drains:_______ Tubes______ Ostomy Bag:___________
Labs:__________________________________________________Needed Labs:____________________________
Future Procedures:______________________________________________________________________________
**********************************************************Patient Name:__________________________ Patient Room:_________ DOB:___________ Sex:__
Doctors:
Diagnosis:
Allergies:
History:
Code Status:
VS: 0700 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
1200 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
1600 BP:________HR:_______ Temp:______O2 Sat:__________ O2:_____ RR:______Pain:________
Blood Sugars: 0700___________ 1200_________ 1700_____________2200______________
Med Pass: 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 0100
0200 0300 0400 0500 0600
Intake: Breakfast_____________Lunch_______________Supper_____________ ____ Other:________________
Output: Foley___________BM:________ Emesis_______Drains:_______ Tubes______ Ostomy Bag:___________
Labs:__________________________________________________Needed Labs:____________________________
Future Procedures:______________________________________________________________________________
