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STI COLLEGE

College of Nursing

PATIENT’S DATA SHEET

Name: _______________________________ Religion: __________________________


Age/Sex: _____________________________ Attending Physician: ________________
Address: _____________________________________________________________________
Diagnosis: ___________________________________________________________________

KARDEX
Diet Endorsements IVF/BT Medications

VITAL SIGNS
02 Sat Intake Output
Time T (⁰C) P (bpm) R (cpm) BP (mmHg) HGT Stool
(%) P.O IVF Urine

NURSE’S NOTES

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