Daily Patient Census Report
Complete this form to report the daily patient census for your unit or department.
Date of Report
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility/Unit Name
*
Name of Person Completing Report
*
First Name
Last Name
Role/Title
*
Shift
*
Please Select
Day
Evening
Night
Other
Number of Patients at Start of Day
*
Number of Admissions Today
*
Number of Discharges Today
*
Number of Transfers In Today
*
Number of Transfers Out Today
*
Number of Deaths Today
Number of Patients at End of Day
*
Comments or Special Notes
Submit Report
Should be Empty: