TPR Sheet

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GRAPHIC CHART

Name of Patient: Ward/Room:


Address:
Age:
Sex: Admission Date:

Date
Hospital Days
Post-Op/Post-Partu
AM PM AM PM AM PM
Hour 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12
Pulse
Rate
Temperature

150

140 40.0

130

120 39. 0

110

100 38.0

90

80 37.0

70

60 36.0

50 35.5

Respirations
Blood Pressure
Weight
7a-3p 3p-11p 11p-7a TOTAL 7a-3p 3p-11p 11p-7a TOTAL 7a-3p 3p-11p 11p-7a TOTAL
Diet
Intake: Oral
Parenteral
TOTAL INTAKE
Urine (cc)/ No, of Tim
Drainage
Emesis
TOTAL OUTPUT
Stool/ No. of Times
(Name, Middle,

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