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  • Mini SBAR Report Sheet

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    the201girls
    8 views3 pages
    This document contains a patient's admission information including their name, age, gender, admitting diagnosis, allergies, attending physician, room number, code status, past medical history, current tests, vital signs, pain levels, intravenous access and fluids, neurological and physical exam findings, and plan of care. Sections are included to document the patient's situation, tests, intravenous access, vital signs, neurological, cardiac, respiratory, gastrointestinal, genitourinary, and skin exams, with spaces to record ongoing notes.

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    This document contains a patient's admission information including their name, age, gender, admitting diagnosis, allergies, attending physician, room number, code status, past medical history, current tests, vital signs, pain levels, intravenous access and fluids, neurological and physical exam findings, and plan of care. Sections are included to document the patient's situation, tests, intravenous access, vital signs, neurological, cardiac, respiratory, gastrointestinal, genitourinary, and skin exams, with spaces to record ongoing notes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    8 views3 pages

    Mini SBAR Report Sheet

    Uploaded by

    the201girls
    This document contains a patient's admission information including their name, age, gender, admitting diagnosis, allergies, attending physician, room number, code status, past medical history, current tests, vital signs, pain levels, intravenous access and fluids, neurological and physical exam findings, and plan of care. Sections are included to document the patient's situation, tests, intravenous access, vital signs, neurological, cardiac, respiratory, gastrointestinal, genitourinary, and skin exams, with spaces to record ongoing notes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 3

    Name: _____________ Diagnosis: __________ Consults: Room #: ____________

    Age: ____ y/o M / F Allergies: ___________ Attending: __________


    Admitted: ___________ Isolation: ___________ Code Status: ________

    Situation: PMH: DM / CHF / HTN / CAD / HLD / PVD / COPD / CKD /


    Hypothyroid / Smoker / ETOH / Drug Abuse / Psych / CVA /
    Dementia / _____________________

    Tests: Pain: IV: ________________ IVF: NS / ____ @ ____ Accu✓: AC/HS / Q __


    Date: ______________ Drips: Abx / Hep / Dilt B _______ D _______
    Central: ____________ TPN / Blood L _______ HS_______

    Neuro Cardiac Resp GI & GU Skin:

    A&O x __ / Confused Rhythm: ____________ O2: __L / RA Diet: _____ BM: ______
    Activity: ____________ Edema: _____________ Sounds: ____________ Diarrhea / Incontinent Labs:
    Neuro✓: Q __ Pulses: _____________ CPAP / BIPAP / Nebs Voiding / Foley
    Notes: _____________ Notes: _____________ Notes: _____________ Notes: _____________

    Plan:

    Name: _____________ Diagnosis: __________ Consults: Room #: ____________


    Age: ____ y/o M / F Allergies: ___________ Attending: __________
    Admitted: ___________ Isolation: ___________ Code Status: ________

    Situation: PMH: DM / CHF / HTN / CAD / HLD / PVD / COPD / CKD /


    Hypothyroid / Smoker / ETOH / Drug Abuse / Psych / CVA /
    Dementia / _____________________

    Tests: Pain: IV: ________________ IVF: NS / ____ @ ____ Accu✓: AC/HS / Q __


    Date: ______________ Drips: Abx / Hep / Dilt B _______ D _______
    Central: ____________ TPN / Blood L _______ HS_______

    Neuro Cardiac Resp GI & GU Skin:

    A&O x __ / Confused Rhythm: ____________ O2: __L / RA Diet: _____ BM: ______
    Activity: ____________ Edema: _____________ Sounds: ____________ Diarrhea / Incontinent Labs:
    Neuro✓: Q __ Pulses: _____________ CPAP / BIPAP / Nebs Voiding / Foley
    Notes: _____________ Notes: _____________ Notes: _____________ Notes: _____________

    Plan:
    Name: _____________ Diagnosis: __________ Consults: Room #: ____________
    Age: ____ y/o M / F Allergies: ___________ Attending: __________
    Admitted: ___________ Isolation: ___________ Code Status: ________

    Situation: PMH: DM / CHF / HTN / CAD / HLD / PVD / COPD / CKD /


    Hypothyroid / Smoker / ETOH / Drug Abuse / Psych / CVA /
    Dementia / _____________________

    Tests: Pain: IV: ________________ IVF: NS / ____ @ ____ Accu✓: AC/HS / Q __


    Date: ______________ Drips: Abx / Hep / Dilt B _______ D _______
    Central: ____________ TPN / Blood L _______ HS_______

    Neuro Cardiac Resp GI & GU Skin:

    A&O x __ / Confused Rhythm: ____________ O2: __L / RA Diet: _____ BM: ______
    Activity: ____________ Edema: _____________ Sounds: ____________ Diarrhea / Incontinent Labs:
    Neuro✓: Q __ Pulses: _____________ CPAP / BIPAP / Nebs Voiding / Foley
    Notes: _____________ Notes: _____________ Notes: _____________ Notes: _____________

    Plan:

    Name: _____________ Diagnosis: __________ Consults: Room #: ____________


    Age: ____ y/o M / F Allergies: ___________ Attending: __________
    Admitted: ___________ Isolation: ___________ Code Status: ________

    Situation: PMH: DM / CHF / HTN / CAD / HLD / PVD / COPD / CKD /


    Hypothyroid / Smoker / ETOH / Drug Abuse / Psych / CVA /
    Dementia / _____________________

    Tests: Pain: IV: ________________ IVF: NS / ____ @ ____ Accu✓: AC/HS / Q __


    Date: ______________ Drips: Abx / Hep / Dilt B _______ D _______
    Central: ____________ TPN / Blood L _______ HS_______

    Neuro Cardiac Resp GI & GU Skin:

    A&O x __ / Confused Rhythm: ____________ O2: __L / RA Diet: _____ BM: ______
    Activity: ____________ Edema: _____________ Sounds: ____________ Diarrhea / Incontinent Labs:
    Neuro✓: Q __ Pulses: _____________ CPAP / BIPAP / Nebs Voiding / Foley
    Notes: _____________ Notes: _____________ Notes: _____________ Notes: _____________

    Plan:
    Name: _____________ Diagnosis: __________ Consults: Room #: ____________
    Age: ____ y/o M / F Allergies: ___________ Attending: __________
    Admitted: ___________ Isolation: ___________ Code Status: ________

    Situation: PMH: DM / CHF / HTN / CAD / HLD / PVD / COPD / CKD /


    Hypothyroid / Smoker / ETOH / Drug Abuse / Psych / CVA /
    Dementia / _____________________

    Tests: Pain: IV: ________________ IVF: NS / ____ @ ____ Accu✓: AC/HS / Q __


    Date: ______________ Drips: Abx / Hep / Dilt B _______ D _______
    Central: ____________ TPN / Blood L _______ HS_______

    Neuro Cardiac Resp GI & GU Skin:

    A&O x __ / Confused Rhythm: ____________ O2: __L / RA Diet: _____ BM: ______
    Activity: ____________ Edema: _____________ Sounds: ____________ Diarrhea / Incontinent Labs:
    Neuro✓: Q __ Pulses: _____________ CPAP / BIPAP / Nebs Voiding / Foley
    Notes: _____________ Notes: _____________ Notes: _____________ Notes: _____________

    Plan:

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