Dept X-Ray

Register

TAT SL No Date & Time of X Ray Patient Name

CRITICAL VALUE SL No Patient Name Age/sex

Reporting Error SL No Patient Name Age/sex

Redos SL No Patient Name Age/sex

path Lab SL No Date & Time of Sample Patient Name

TAT collection

CRITICAL VALUE SL No Patient Name Age/sex

collection

Reporting Error SL No Patient Name Age/sex

EMERGENCY

HANDOVER SL No Patient Name Age/sex

REGISTER N/S

RMO REGISTER SL No Patient Name Age/sex

NURSING STAFF

Rapid Response SL No UHID/IPD/OPD Warning Sign

Team

MLC SL No Patient Name UHID No

Pvt Ward
Handover register SL No Patient Name Age/sex
Nursing Staff

RMO Register SL No Patient Name Age/sex

Nursing Staff

Rapid Response SL No UHID/IPD/OPD Warning Sign

Team

Investigation Reg SL No Patient Name Date

Neddle Stick SL No Date Employee Name

Injury

Cauti SL No Patient Name UHID No

Surveillance OPD

Clabsi SL No Patient Name UHID No

Surveillance OPD

SEMI PVT WARD

HANDOVER REG SL No Patient Name Age/Sex

RMO Register SL No Patient Name Age/Sex

Nursing Staff

Rapid Response SL No UHID/IPD/OPD Warning Sign

Team

Cauti SL No Patient Name UHID No

Surveillance OPD
Clabsi SL No Patient Name UHID No
Surveillance OPD

ICU

HANDOVER REG SL No Patient Name Age/Sex

RMO Register SL No Patient Name Age/Sex

Nursing Staff

Rapid Response SL No UHID/IPD/OPD Warning Sign

Team

Cauti SL No Patient Name UHID No

Surveillance OPD

Clabsi SL No Patient Name UHID No

Surveillance OPD

VAP SL No Patient Name UHID No

Surveillance OPD
Record

LABOUR WARD

HANDOVER REG SL No Patient Name Age/Sex

RMO Register SL No Patient Name Age/Sex

Nursing Staff

Cauti SL No Patient Name UHID No

Surveillance OPD

Rapid Response SL No UHID/IPD/OPD Warning Sign

Team
Age/sex UHID No IPD NO X-RAY NAME

UHID No IPD NO TEST NAME & CRITICAL DATE & TIME

VALUE OF RESULT OUT

UHID No IPD NO TEST NAME & CRITICAL DATE & TIME

VALUE OF RESULT OUT

UHID No IPD NO REDOS BRIEF REASOM FOR

SUMMARY ERROR

Age/sex UHID No IPD NO TEST NAME

UHID No IPD NO TEST NAME & CRITICAL DATE & TIME OF

VALUE RESULT OUT

UHID No IPD NO REPORTING ERROR TYPE OF ERROR

BRIEF SUMMARY MAJOR/MONOR

UHID No IPD NO PANEL DIAGNOSIS

OPD

UHID No IPD NO PANEL DIAGNOSIS

OPD

Informed Time of Informed by Name Emp Action Taken by

to Information ID Doctors

MLC Doctors Transfer Patient Inform to P.S

Case Name Doctors
UHID No Panel Diagnosis Dept.
OPD

UHID No Panel Diagnosis Dept.

OPD

Informed Time of Informed by Name Emp Action Taken by

to Information ID Doctors

UHID No Time & Investigation Nursing Staff

OPD Room Sign

Doctor Vaccination Action Taken Remarks

IPD No Date of Date of Change Date of Removal

Insertion

IPD No Date of Date of Change Date of Removal

Insertion

UHID /IPD Panel Diagnosis Dept

OPD no

UHID /IPD Panel Diagnosis Dept

OPD no

Informed Time of Informed by Name Emp Action Taken by

to Information ID Doctors

IPD No Date of Date of Change Date of Removal

Insertion
IPD No Date of Date of Change Date of Removal
Insertion

UHID /IPD Panel Diagnosis Dept

OPD no

UHID /IPD Panel Diagnosis Dept

OPD no

Informed Time of Informed by Name Emp Action Taken by

to Information ID Doctors

IPD No Date of Date of Change Date of Removal

Insertion

IPD No Date of Date of Change Date of Removal

Insertion

IPD No Date of Date of Change Date of Removal

Intubation

UHID /IPD Panel Diagnosis Dept

OPD no

UHID /IPD Panel Diagnosis Dept

OPD no

IPD No Date of Date of Change Date of Removal

Insertion

Informed Time of Informed by Name Emp Action Taken by

to Information ID Doctors
REPORT DATE & TIME DISPATCH REPORT CONSULTANT
OF RESULT OUT DATE & TIME NAME

REPORTING TIME FILM SIZE INFORMED TO INCHARGE

OF DOCTOR NAME & SIGN

REPORTING TIME FILM SIZE INFORMED TO INCHARGE

OF DOCTOR NAME & SIGN

CORRECTIVE FILM SIZE INFORMED TO INCHARGE

ACTION NAME & SIGN

REPORT DATE & TIME DISPATCH REPORT CONSULTANT

OF RESULT OUT DATE & TIME NAME

REPORTING TIME INFORMED TO INCHARGE NAME

OF DOCTOR & SIGNATURE

REASON FOR CORRECTIVE PREVENTIVE INCHARGE

ERROR ACTION ACTION NAME & SIGN

DEPT ILLNESS MORNING OVER EVENING OVER

SEVERITY WITH SIGN WITH SIGN

DEPT ILLNESS MORNING OVER EVENING OVER

SEVERITY WITH SIGN WITH SIGN

Name & sign

of Doctor

Sign
illness Severty Morning EVENING OVER NIGHT OVER
Over with sign WITH SIGN WITH SIGN

illness Severty Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Name & sign

of Doctor

Lab staff sign

Fever TLC Folley's Bag Above

Care Done Ground

Fever TLC Folley's Bag Above

Care Done Ground

Illness severity Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Illness severity Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Name & sign

of Doctor

Fever TLC Folley's Bag Above

Care Done Ground
Fever TLC Folley's Bag Above
Care Done Ground

Illness severity Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Illness severity Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Name & sign

of Doctor

Fever TLC Folley's Bag Above

Care Done Ground

Fever TLC Folley's Bag Above

Care Done Ground

Fever TLC Folley's Peep

Care Done

Illness severity Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Illness severity Morning EVENING OVER NIGHT OVER

Over with sign WITH SIGN WITH SIGN

Fever TLC Folley's Bag Above

Care Done Ground

Name & sign

of Doctor
INCHARGE
NAME & SIGN

PATIENT
SIGN

PATIENT
SIGN

PATIENT
SIGN

INCHARGE
NAME & SIGN

REMARKS

NIGHT OVER REMARKS

WITH SIGN

NIGHT OVER REMARKS

WITH SIGN
Remarks

Remarks

Catheter Pre Urine Report Post Report Antibiotic

Properly Culture Sent Urine

Catheter Pre Urine Report Post Report Antibiotic

Properly Culture Sent Urine

Remarks

Remarks

Catheter Pre Urine Report Post Report Antibiotic

Properly Culture Sent Urine
Catheter Pre Urine Report Post Report Antibiotic
Properly Culture Sent Urine

Remarks

Remarks

Catheter Pre Urine Report Post Report Antibiotic

Properly Culture Sent Urine

Catheter Pre Urine Report Post Report Antibiotic

Properly Culture Sent Urine

Tracheostomy Tracheostomy Dressing has Culture Report Antibiotic

Care done Properly adherd Date of Insertion Sent

Remarks

Remarks

Catheter Pre Urine Report Post Report Antibiotic

Properly Culture Sent Urine
Outcome

Outcome

Outcome
Outcome

Outcome

Outcome

Outcome

Outcome