Nursing Patient Report Sheet
Document and communicate essential patient information for nursing care and shift handover.
Patient Full Name
*
First Name
Last Name
Patient Admission Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Patient Room/Bed Number
*
Patient Age
*
Primary Diagnosis/Reason for Admission
*
Allergies (if any)
Vital Signs
Rows
Temperature (°C)
Pulse (bpm)
Respiratory Rate (breaths/min)
Blood Pressure (mmHg)
Oxygen Saturation (%)
Morning
Afternoon
Evening
Nursing Assessment
Consciousness Alert
Oriented
Ambulatory
Bedridden
Skin Intact
Pressure Ulcer Present
IV Access
Catheter
Other
Medications Administered (name, dose, time)
Treatments/Procedures Performed
Intake/Output (ml)
Rows
Oral Intake
IV Intake
Urine Output
Other Output
Morning
Afternoon
Evening
Additional Observations/Notes
Nurse's Full Name
*
First Name
Last Name
Date and Time of Report
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Nurse's Signature (to confirm accuracy of report)
*
Submit Report
Submit Report
Should be Empty: