Date
Shift
Unit
Tech
Charge
Rm Name · age Allergies
Dx
Diet Activity Lines · drains
FullDNRDNIIsoFallTele
Vitals
| Time | | | |
|---|
| BP | | | |
|---|
| HR | | | |
|---|
| RR | | | |
|---|
| Temp | | | |
|---|
| SpO₂ | | | |
|---|
| Pain | | | |
|---|
| Glucose | | | |
|---|
Notes · tell the next shift
Rm Name · age Allergies
Dx
Diet Activity Lines · drains
FullDNRDNIIsoFallTele
Vitals
| Time | | | |
|---|
| BP | | | |
|---|
| HR | | | |
|---|
| RR | | | |
|---|
| Temp | | | |
|---|
| SpO₂ | | | |
|---|
| Pain | | | |
|---|
| Glucose | | | |
|---|
Notes · tell the next shift
Rm Name · age Allergies
Dx
Diet Activity Lines · drains
FullDNRDNIIsoFallTele
Vitals
| Time | | | |
|---|
| BP | | | |
|---|
| HR | | | |
|---|
| RR | | | |
|---|
| Temp | | | |
|---|
| SpO₂ | | | |
|---|
| Pain | | | |
|---|
| Glucose | | | |
|---|
Notes · tell the next shift
Who this sheet is for
Three patients, a third of the page each. It is for a lighter med-surg assignment, a step between the two-patient and the four-patient sheet.
Keep the same order in all three blocks. The top lines are for report: room, allergies, diagnosis, diet, activity, lines and drains, and the code and safety boxes. The middle row holds vitals three times with glucose, meds by the time they are due, and labs or tests you are waiting on. Before you hand off, fill in intake and output and write what the next nurse needs to hear first.
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.
