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
Rm Name · age
Dx
Allergies
Diet Lines
FullDNRDNIIsoFallTele
Who this sheet is for
Six patients on one page. This is the sheet for a big assignment, when you need every patient in front of you and only the essentials for each.
Every box has the same layout: room, name and age, diagnosis, allergies, diet and lines, then code and safety boxes, two sets of vitals, meds by time, three to-dos and a few lines for notes. If you need more room for one patient, print the one-patient sheet for that person and keep this one for the overview.
Use the top line for date, shift, unit, your tech and the charge nurse, so the sheet still makes sense if you pick it up the next morning.
Blocks worth knowing
- Vitals
- two sets per patient; write the time in the header
- Meds
- time and drug for what is due this shift
- To do · Notes
- the short list to get through and what to pass on
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.