Clinical Flowsheet

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Pt: __________________________________ ___________________

Dx: _____________________________________________________

Hx: _________________________________________________________________________________________________________________________
NDx: _______________________________________________________________________________________________________________________
Temp

BP

Medication

Dressing Location

o
o
o
o
o
o
o
4:00-5:00
5:00-6:00
6:00-7:00
8:00-9:00
9:00-10:00
10:00-11:00

Respirations

Dose

Route

Orders

Heart Rate

Pulse Ox

Time

Pain

Dx

Time

Blood sugars: ________________ _________________ ___________________


I & Os: _________________ ________________ __________________
Tube feeding: ______________________________________________________
IV location: ________________ Solution: _____________ Rate: ________________
ROM exercises
o Incontinent Care
Turn & Reposition: ___________ ___________ __________ ______________
Specimens: __________________________________________________________

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