Rm# Age: Doctor/Consults:

Reason for Admit

Name:

Rm# Age:
Abnormal and pertinent normal assessment findings: Neuro: Admit date: Resp: CV: Rhythm:

Name:

Doctor/Consults:
Reason for Admit Admit date:

Abnormal and pertinent normal assessment findings: Neuro: Resp: CV: Rhythm:

Past Medical History:

Gi/Gu: M/S: Diet: BGTs I/O: Integ: Activity: Code Status: Isolation: Pain Management:

Past Medical History:

Gi/Gu: M/S: Diet: BGTs I/O: Integ: Pain Management:

Activity:

Code Status:

Isolation:

Resp Tx: O2

Monitor:

Wt: Vital signs: T: HR: RR: BP: O2%:

Resp Tx: O2

Monitor:

Wt: Vital signs: T: HR: RR: BP: O2%:

IVs/fluids Wound/Tube Care: NG Foley Meds:

IVs/fluids Wound/Tube Care: NG Foley

I/O:

I/O:

Critical/Priority lab/diagnostic test results

Meds:

Critical/Priority lab/diagnostic test results

Allergies Nursing Notes:

Labs/Diagnostics/Procedures to be done this shift

Allergies Nursing Notes:

Labs/Diagnostics/Procedures to be done this shift

Shift Goals

Shift Goals