Date
Shift
RN
Tech
Charge
| Time | Patient 1 | Patient 2 | Patient 3 | Patient 4 |
|---|---|---|---|---|
| Room | ||||
| Name · age | ||||
| Dx | ||||
| Code | Full · DNR · DNI | Full · DNR · DNI | Full · DNR · DNI | Full · DNR · DNI |
| Allergies | ||||
| Diet | ||||
| Iso · fall | Cont · Drop · Air · Fall | Cont · Drop · Air · Fall | Cont · Drop · Air · Fall | Cont · Drop · Air · Fall |
| Lines | ||||
| 07001900 | ||||
| 08002000 | ||||
| 09002100 | ||||
| 10002200 | ||||
| 11002300 | ||||
| 12000000 | ||||
| 13000100 | ||||
| 14000200 | ||||
| 15000300 | ||||
| 16000400 | ||||
| 17000500 | ||||
| 18000600 | ||||
| Labs · tests pending | ||||
| Tell the next shift |
Not a medical record. Shred at end of shift.
Day hours on top · night hours under them