Student Name ________________________________________ Date ___________________________
Unit/Room # ______________
RN caring for patient ______________________________
Pt Age _________ Admit Date __________ Admit Diagnosis ___________________________________
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Nursing Diagnosis______________________________________________________________________
SBAR REPORT
Situation (A brief statement of the reason hospitalized)
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Background (Pertinent information related to the situation. Includes pertinent medical history,
concomitant diseases, synopsis of hospital course, significant family/social situation, allergies, IV’s, meds
and treatments performed, vital signs, etc.)
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Assessment (Your assessment and analysis of the situation or problem, and plan of care using critical
thinking skills. May be in response to a change in pt. status
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Recommendation/Response (Your recommendation or request? What are the nursing goals? What is
the response to interventions?)
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Notes
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