SMS / REFERRALS DIAGNOSTICS STAFFING CONSULTANT:

 _______________________  _______________________ AM SHIFT PM SHIFT RT:

 _______________________  _______________________ ACN: ___________ ACN: ___________ BED PATIENT NURSE

 _______________________  _______________________ PCN: ___________ PCN: ___________ ISO _____________ _______

 _______________________  _______________________ CN: ____________ CN: ____________ C 01 _____________ _______

 _______________________  _______________________ BNs: ___________ BNs: ___________ C 02 _____________ _______

 _______________________  _______________________ BNs: ___________ BNs: ___________ C 03 _____________ _______

 _______________________  _______________________ BNs: ___________ BNs: ___________ C 04 _____________ _______

 _______________________  _______________________ BNs: ___________ BNs: ___________ C 05 _____________ _______

 _______________________  _______________________ BNs: ___________ BNs: ___________ C 06 _____________ _______

OR PROCEDURES CV LAB PROCEDURES NA/NO: ________ NA/NO: ________ C 07 _____________ _______

 _______________________  _______________________ DOCTOR'S ROUNDS NOTES C 08 _____________ _______

 _______________________  _______________________ Dr. ____________ _______________ C 09 _____________ _______

 _______________________  _______________________ Dr. ____________ _______________ C 10 _____________ _______

 _______________________  _______________________ Dr. ____________ _______________ C 11 _____________ _______

 _______________________  _______________________ Dr. ____________ _______________ C 12 _____________ _______

 _______________________  _______________________ Dr. ____________ _______________ C 14 _____________ _______

 _______________________  _______________________ LOGBOOKS THINGS TO DO : C 15 _____________ _______

X-RAY 2D ECHO ECG  Endorsement  12O / 24O Check C 16 _____________ _______

Sheet
 SBAR Update
 ______________  ______________  ______________ C 17 _____________ _______
 Charge Nurse  Info. Board
 ______________  ______________  ______________ Endorsement C 18 _____________ _______
 Patient  SSBBC
 ______________  ______________  ______________ (Notice of Discharge) C 19 _____________ _______
Assignment
 Admission &  Procedure
 ______________  ______________  ______________ C 20 _____________ _______
Discharge Checklist
 ______________  ______________  ______________  Turn Around OTHER PROCEDURES
 Lab. Results
Time
 ______________  ______________  ______________  Statistics  Consents  _________________________
(Computer/Logbook)
 ______________  ______________  ______________ Daily Dashboard  Call Blood Bank  _________________________
 Call ICU
 ______________  ______________  ______________  _________________________