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Audit

General Information
Date of Birth

Sex

Patient Report

Diagnosis

Does the patient has allergies?

Please enter details

Patient medical history

Code status

Patient Monitoring - Vital Signs

Click + to add patient monitoring details

Patient Check
Time Check

Blood Pressure

Heart Rate

Temperature

Oxygen Saturation

Oxygen

Respiratory Rate

Pain

Blood Sugars

Are there dispensed medications?

Time of Med Pass
Intake

Breakfast

Lunch

Supper

Other

Output

Foley

BM

Emesis

Drains

Tubes

Ostomy Bag

Labs and Needed Procedures

Labs

Needed Labs

Future Procedures

Completion

Click + to add Nurse On Duty

Nurse
Full Name and Signature of Nurse Attendee

Nursing Report Sheet Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 49

This Nurse Report Sheet can be used by nursing staff during ward or room visits. Start by entering the patient’s general information. Next, record diagnosis and the medical history. It is also important to take note any allergy and special conditions. The template then prompts the user to record vital signs of the patient such as blood pressure, heart rate, temperature, and blood sugar. Med passes should also be recorded to ensure that medicines are dispensed accordingly. Document the patient’s food intake during breakfast, lunch, or supper. Lastly, write down any future procedure needed to inform the next nurses-on duty. Complete the report by providing a digital signature. Use iAuditor to perform digital patient checks with the use of your handheld device. You may also customize this template based on your needs.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

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Audit

General Information
Date of Birth

Sex

Patient Report

Diagnosis

Does the patient has allergies?

Please enter details

Patient medical history

Code status

Patient Monitoring - Vital Signs

Click + to add patient monitoring details

Patient Check
Time Check

Blood Pressure

Heart Rate

Temperature

Oxygen Saturation

Oxygen

Respiratory Rate

Pain

Blood Sugars

Are there dispensed medications?

Time of Med Pass
Intake

Breakfast

Lunch

Supper

Other

Output

Foley

BM

Emesis

Drains

Tubes

Ostomy Bag

Labs and Needed Procedures

Labs

Needed Labs

Future Procedures

Completion

Click + to add Nurse On Duty

Nurse
Full Name and Signature of Nurse Attendee