Healthcare Staff Handover Information Form
Use this form to hand over patient care, shift updates, pending tasks, risks, and follow-up instructions between healthcare staff.
Shift and Staff Details
Handover Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift Type
*
Morning
Evening
Night
Other
Handing-off Staff Member Name
*
Handing-off Staff Member Role
*
Receiving Staff Member Name
*
Receiving Staff Member Role
*
Department / Unit / Ward
*
Patient or Case Handover Summary
Patient Name
First Name
Middle Name
Last Name
Case Identifier
Bed Number / Location
*
Primary Diagnosis / Reason for Admission
*
Current Overall Status
*
Please Select
Stable
Improving
Deteriorating
Critical
Discharged/Ready for Discharge
Other
Brief Handover Summary
*
Clinical Status and Care Needs
Medications, Treatments, and Pending Tasks
Medications due
Treatments or procedures completed
Treatments or procedures pending
Outstanding tasks for next shift
Deadlines and timing notes
Risks, Escalations, and Follow-up
Current risks or concerns
*
Fall risk
Pressure injury risk
Aspiration risk
Infection control concern
Deteriorating vital signs
Behavioral or safety concern
Allergy concern
Other
Escalation criteria met?
*
Yes, escalate now
No, continue routine monitoring
Unclear, seek senior review
Other
When to contact a doctor or senior clinician
*
New or worsening symptoms
Abnormal vital signs
Reduced level of consciousness
Severe pain or distress
Bleeding or suspected sepsis
Medication reaction or concern
Change in mobility or function
Other
Follow-up instructions and special notes for the next staff member
*
Equipment or supplies needing attention
Oxygen equipment
IV access supplies
Wound care supplies
Mobility aids
Monitoring equipment
Personal protective equipment
Other
Submit Handover
Should be Empty: