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4 PT Report Sheet

The document contains patient information including name, age, gender, medical history, medications, test results, and safety checks for multiple patients. It lists clinical information in a table format with times for checks.

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Anees
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Download as PDF, TXT or read online on Scribd
59 views

4 PT Report Sheet

The document contains patient information including name, age, gender, medical history, medications, test results, and safety checks for multiple patients. It lists clinical information in a table format with times for checks.

Uploaded by

Anees
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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NAME: CODE STATUS: ROOM: NAME: CODE STATUS: ROOM:

AGE: ALLERGIES: FAMILY: AGE: ALLERGIES: FAMILY:


GENDER: PHYSICIAN: ADMITTED: GENDER: PHYSICIAN: ADMITTED:
PMH: HISTORY: IV ACCESS/FLUID/DRIP: PMH: HISTORY: IV ACCESS/FLUID/DRIP:

HX: HX:
MEDICATION: TEST: TEST:
DM HTN DM HTN MEDICATION:
CKD OSA OSA
CKD
HLP Smoker Smoker
HLP
Obesity CHF CHF
Obesity

RESPIRATORY: RESPIRATORY:
SPO2
GI/GU: GI/GU:
SPO2

SKIN: Diet
SKIN: Diet
ETT
TF ETT
TF
TF TF
Wound Foley Wound Foley

NEURO: Care
NEURO: Care
SITUATION: SITUATION:
A & Ox Others Others
A & Ox

VITAL SIGNS: VITAL SIGNS:


CARDIAC: BP
CARDIAC: BP
TEMP TEMP
Rhythm X SYSTOLIC LABS: Rhythm LABS:
X SYSTOLIC
Na CO2 Hct Na CO2 Hct
Edima X DIASTOLIC Edima X DIASTOLIC
PULSE O CI BUN Hgb PULSE O CI BUN Hgb
Pulse Pulse
K GIu PIt K GIu PIt
Cr WBC
MUSCULOSKELETAL: MUSCULOSKELETAL: Cr WBC

General Weakness General Weakness


0800 2000 0800 2000
Limited Movement Limited Movement
0900 2100 0900 2100
1000 2200 1000 2200
SAFETY CHECKS: SAFETY CHECKS:
ADD O SUPPLY 1100 2300 ADD O SUPPLY 1100 2300
SUCTION WORKS SUCTION WORKS
1200 0000 1200
BED WHEELS LOCK BED WHEELS LOCK
0000
SIDE RAILS UP 1300 0100 SIDE RAILS UP 1300 0100
C. MONITOR ALARM ON 1400 0200 C. MONITOR ALARM ON 1400
BED SIDE ANGISED
0200
BED SIDE ANGISED
1500 0300 1500 0300
DIAGNOSTICS: 1600 0400 DIAGNOSTICS: 1600 0400
1700 0500 1700 0500
1800 1800
0600 0600
1900 0700 1900 0700

NAME: CODE STATUS: ROOM: NAME: CODE STATUS: ROOM:


AGE: ALLERGIES: FAMILY: AGE: ALLERGIES: FAMILY:
GENDER: PHYSICIAN: ADMITTED: GENDER: PHYSICIAN: ADMITTED:
PMH: HISTORY: IV ACCESS/FLUID/DRIP: PMH: HISTORY: IV ACCESS/FLUID/DRIP:

HX: HX:
MEDICATION: TEST: TEST:
DM HTN DM HTN MEDICATION:
CKD OSA CKD OSA
HLP Smoker HLP Smoker
Obesity CHF Obesity CHF

RESPIRATORY: RESPIRATORY:
SPO2
GI/GU: SPO2
GI/GU:

SKIN: Diet
SKIN: Diet
ETT
TF ETT
TF
TF TF
Wound Foley Wound Foley

NEURO: Care NEURO: Care


SITUATION: SITUATION:
A & Ox Others A & Ox Others

VITAL SIGNS: VITAL SIGNS:


CARDIAC: BP CARDIAC: BP
TEMP TEMP
Rhythm X SYSTOLIC LABS: Rhythm X SYSTOLIC LABS:
Na CO2 Hct Na CO2 Hct
Edima X DIASTOLIC Edima X DIASTOLIC
PULSE O CI BUN Hgb PULSE O CI BUN Hgb
Pulse Pulse
K GIu PIt K GIu PIt
Cr WBC
MUSCULOSKELETAL: MUSCULOSKELETAL: Cr WBC

General Weakness General Weakness

0800 2000 0800 2000


Limited Movement Limited Movement
0900 2100 0900 2100
1000 2200 1000 2200
SAFETY CHECKS: SAFETY CHECKS:
ADD O SUPPLY 1100 2300 ADD O SUPPLY 1100 2300
SUCTION WORKS SUCTION WORKS
1200 0000 1200 0000
BED WHEELS LOCK BED WHEELS LOCK
SIDE RAILS UP 1300 0100 SIDE RAILS UP 1300 0100
C. MONITOR ALARM ON 1400 0200 C. MONITOR ALARM ON 1400 0200
BED SIDE ANGISED BED SIDE ANGISED
1500 0300 1500 0300
DIAGNOSTICS: 1600 0400 DIAGNOSTICS: 1600 0400
1700 0500 1700 0500
1800 1800
0600 0600
1900 0700 1900 0700

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