PATIENT NAME:

[PATIENT'S NAME]

ROOM NUMBER:

[ROOM NUMBER]

BRIEF SUMMARY:

[BRIEF SUMMARY OF PATIENT'S CONDITION AND ANY RECENT DEVELOPMENTS]

CURRENT VITAL SIGNS:

[LIST OF CURRENT VITAL SIGNS]

PRIMARY CONCERN:

[PRIMARY CONCERN OR ISSUE REQUIRING ATTENTION]

CODE STATUS:

[PATIENT'S CURRENT CODE STATUS]

RECENT CHANGES:

[ANY RECENT CHANGES IN CONDITION OR TREATMENT]

MEDICAL HISTORY:

[BRIEF OVERVIEW OF PATIENT'S MEDICAL HISTORY]

ALLERGIES:

[LIST OF KNOWN ALLERGIES]

CURRENT MEDICATIONS:

[LIST OF CURRENT MEDICATIONS AND DOSAGES]

RECENT PROCEDURES:

[RECENT PROCEDURES UNDERGONE BY THE PATIENT]

FAMILY INFORMATION:

[INFORMATION ABOUT FAMILY INVOLVEMENT AND SUPPORT]

PRIMARY ASSESSMENT:

[ASSESSMENT FINDINGS RELATED TO PRIMARY CONCERN]

SECONDARY ASSESSMENT:

[ADDITIONAL ASSESSMENT FINDINGS]

CURRENT SYMPTOMS:

[LIST OF CURRENT SYMPTOMS OBSERVED]

LAB RESULTS:

[SUMMARY OF RELEVANT LAB RESULTS]

DIAGNOSTIC TESTS:

[PENDING OR COMPLETED DIAGNOSTIC TESTS]

PAIN LEVEL:

[PATIENT'S CURRENT PAIN LEVEL, IF APPLICABLE]

IMMEDIATE ACTIONS:

[RECOMMENDED IMMEDIATE ACTIONS OR INTERVENTIONS]

PLAN OF CARE:

[PROPOSED PLAN OF CARE FOR THE UPCOMING SHIFT]

CONSULTATIONS NEEDED:

[ANY NECESSARY CONSULTATIONS OR REFERRALS]

FOLLOW-UP:

[INSTRUCTIONS FOR FOLLOW-UP CARE OR MONITORING]

QUESTIONS/CONCERNS:

[ANY QUESTIONS OR CONCERNS TO ADDRESS DURING THE SHIFT]