| Rm | Name · age | Diet | Out of bed | Toileting | Vitals · CBG | Track | Precautions | Tell the nurse if… |
|---|---|---|---|---|---|---|---|---|
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter | ||||
| Reg · NPO · Thick · Tube · Feed · NAS | Self · ×1 · ×2 · Total · Lift · Chair · Walk | BR · BSC · Bedpan · Foley · Incont · Ostomy | I&OWtTurn q2Bath | Contact · Droplet · Airborne · Fall · Sitter |
Find the nurse now fall · new confusion · chest pain · trouble breathing · temp 100.4 or higher · blood sugar under 70 · pulse or blood pressure outside what the nurse told you · no urine this shift · new red or broken skin · anything that just looks wrong
Who this sheet is for
For nurse techs, patient care techs and nursing assistants who carry a whole hallway. One line per patient, eight patients on one landscape page.
Fill each line in report: room, name and age, diet, how the patient gets out of bed, toileting, how often vitals and blood sugars are due, what to track (intake and output, weight, turns, baths) and precautions. Circle the option that applies rather than writing it out.
The last column is for what the nurse asked you to report right away for that patient. The strip at the bottom lists general reasons to find the nurse now. Your unit's own policy comes first.
Blocks worth knowing
- Out of bed · toileting
- circle the option that applies
- Track
- tick what you are measuring for this patient
- Tell the nurse if…
- what the nurse asked to hear about right away
Every sheet here prints on one US Letter page and comes as a free PDF with no sign-up. It is blank working paper, not a medical record: shred it at the end of the shift. Compare all the sheets or build your own layout.
Keep going
More free sheets
Read before you chart
- The turns you charted every two hours
- The meal percentage and fluid intake nobody adds up
- When a coworker says she gave it but it's not charted
All the sheets · The charting guide · The sitcom behind this site