Hospital Midnight Census
Report key inpatient census details as of midnight. Please complete all relevant fields for accurate census tracking.
Date of Census
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hospital Unit/Ward
*
Please Select
Medical
Surgical
Pediatrics
ICU
Maternity
Psychiatry
Rehabilitation
Other
Bed Number
*
Patient Gender
*
Male
Female
Other/Nonbinary
Unknown
Patient Age Group
*
Please Select
Infant (0-1 year)
Child (1-12 years)
Adolescent (13-17 years)
Adult (18-64 years)
Older Adult (65+ years)
Patient Status at Midnight
*
Admitted Inpatient
Observation
Discharged (before midnight)
Transferred
Deceased
Admission Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Attending Physician
Isolation/Precaution Status
None
Contact Precautions
Droplet Precautions
Airborne Precautions
Other
Additional Notes (if applicable)
Submit Census
Should be Empty: