Hospital Daily Census Report
Please complete this form to report the daily patient census and activity for your hospital unit or ward.
Report Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hospital Name
*
Unit/Ward Name
*
Unit Type
*
Please Select
General Ward
Intensive Care Unit (ICU)
Emergency Department
Pediatrics
Maternity
Surgical
Other
Number of Patients at Start of Day
*
Number of Admissions Today
*
Number of Discharges Today
*
Number of Transfers In
*
Number of Transfers Out
*
Number of Deaths Today
*
Number of Patients at End of Day
*
Breakdown of Patient Types (if applicable)
Rows
Adult
Pediatric
Other
Start of Day
Admissions
Discharges
End of Day
Name and Role of Reporting Staff
*
Additional Notes or Comments
Submit Report
Should be Empty: