Patient Report
Nurse Giving:_________________________ Nurse Receiving:______________________________
Date: ________________________ Time:___________
MRP:__________________________ Unit: ________________________ RM: _______________ Code Status: ________
Patient Name:
DOB:
Birth Wt:
S
Situation
Gestation:
Sex:
Language:
Current Wt:
Religion:
Allergies:
BP:
SPO2:
Corrected Gestation:
Admission Diagnosis:
B
Background
Delivery HX:
APGAR
Vitals:
Time:
Temperature:
RR:
HR:
O2 Therapy:
Mode:
Pain Scale:
Pain Score:
Nutrition:
Last Fed:
Pain Intervention:
Medication:
IVs or Central
Lines:
Drains & Tubes:
Wounds:
Restrictions:
A
Assessment
Neurologic:
Cardiac:
Respiratory:
GI/GU:
Isolation:
Fall Risk:
Integumentary:
Musculoskeletal:
Psychosocial:
Labs &
Diagnostics:
Other:
R
Plan of Care:
Pending Tests:
Recommend
ation
Pending Orders:
Other: