Shift Report:

Patient:  ,  
Shift Date: Shift: Nurse:

Patient Information:

Patient Name: ,  
Patient Date of Birth: 
Mailing Address: 
Address1: 
Address2: 
City:  Island: 
Country: 
Home Telephone:  Work Telephone: 
Cellphone: 
Patient Location: 

Patient Care Notes:

NurseID:  Nurse Name: 

Care Note:Date:  Time: 
 

Medication Administration:

Medication:	Admin Date:	Admin Time:	dosage:	Notes:

Fluids

Time:	Intake/Output	Fluid Amount	Admin Type:	Notes:

Total Fluids
AdminType:	Total
	0.00

Ventilation Records

Time:	FIO2:	RR:	TV:	IP:	IER:	SpO2:	Suction:	Notes:

Patient Vitals

Date:	Time:	Temperature:	Heart Rate:	Respiratory Rate:	Blood Pressure	spO2:	O2M:	Blood Sugar

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Signature

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