Date
Shift
Unit
Tech
Charge
Rm Name · age
Dx
Allergies
Diet Lines
FullDNRDNIIsoFallTele
Rm Name · age
Dx
Allergies
Diet Lines
FullDNRDNIIsoFallTele
Rm Name · age
Dx
Allergies
Diet Lines
FullDNRDNIIsoFallTele
Rm Name · age
Dx
Allergies
Diet Lines
FullDNRDNIIsoFallTele
Rm Name · age
Dx
Allergies
Diet Lines
FullDNRDNIIsoFallTele
Whole shift
To do
Notes · tell the charge nurse
Who this sheet is for
Five patients on one page, the common med-surg assignment. Each patient gets a box with what you need to hand off and nothing more; the sixth box is for the shift as a whole.
In each patient box: room, name and age, diagnosis, allergies, diet, lines, the code and safety boxes, two sets of vitals, meds by the time they are due, a short to-do list and notes. The last box is for things that are not about one patient: calls to return, supplies, what to tell the charge nurse.
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.
Free to print and use. Nothing on it says where it came from, so it is safe to carry
on the floor. It is blank working paper. Do not write a patient's details on it and
leave it lying around. All the sheets →
Related reading: What the handoff note has to carry.
