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Nurse Shift Report
Create a patient log with this Nurse Shift Report. The standard document can be logged between nurses from each shift. After completion of the report the Nurse should sign off and review with the incoming Nurse. All reports then can be placed in the patient file upon discharge.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes


Nurse Shift Report TemplateForm 3511
Format: Word PDF
Category: Medical, Hospital
Type: Report

Nurse Shift Report

Admission Date: ___/___/_____ Allergies: _______________________________________________________________________________________________

Patient Name: __________________________________________ Age: ___________ Sex: ___ Male ___ Female

Admitting Doctor: ____________________________________________________________________________

Advance Directives: ___ DNR ___ Power of Attorney ___ Living Will

Change Nurse today: ___________________________________________________________ Phone Number: _______________________________________

IV Site:

IVF/Rate:

Other Tubes or Drains:

Isolation:

Skin Problems:

O2 Level:

Satting:

Dressings to Change:

Watch For Falling:

Other:

VS1

T

BP

HR

R

O2

Pain

VS2

T

BP

HR

R

O2

Pain

VS3

T

BP

HR

R

O2

Pain

Report I received from RN_______________:

Report to give _______________:

Current medications and rates / dosage: ________________________________________________________________________________________________

PRNS administered: ________________________________________________________________________________________________________________

Specimens sent to lab: ______________________________________________________________________________________________________________

Notes: ____________________________________________________________________________________________________________________________