Nurse's Patient Assessment

Patient's Name*

First NameLast Name

Nurse's Name*

First NameLast Name

Employee Personal Email:*

example@example.com

Nurse:*

Registered Nurse (RN)Licensed Practical Nurse (LPN)

Date*

Date

Time*

:HourMinutesAM/PM Option

Next MD visit:*

Supplies in Home:*

Blood Pressure*

BP arm*

LeftRight

Temp*

Temp Location*

OralAxillaryRectalOther

Resp Rate*

Pulse*

Pulse Location*

RadialApicalOther

Height *

Weight (lbs)*

Mental Status*

Sleep habits*

Gait*

Assistive Devices*

Respirations*

Lung Sounds*

Oxygen Requirements*

Skin / Integumentary

Infection Control

Cardiovascular*

Cough*

Abdomen*

Bowel Sounds (x4 Quad)*

Bowel Habits*

Urinary Habits*

Musculoskeletal*

Upper Extremeties*

Lower Extremeties*

Treatment Provided:*

Intake / Diet

Skin/Wound Assessment:*

Additional Assessment Comments:

Employee Personal Email:*

example@example.com

Nurse Signature

Nurses Direct - Nurse's Patient Assessment

Vital Signs