CHRIST THE KING COLLEGE

Nursing Program
Gingoog City

VITAL SIGNS AND I/O MASTERLIST

RM NAME URINE STOOL INPUT OUTPUT
T PR RR. BP T PR RR BP
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
 CHRIST THE KING COLLEGE
Nursing Program
Gingoog City

VITAL SIGNS AND I/O MASTERLIST

BEDSIDE NURSE

DATE: _________________________________ Area: ____________________________

RM NAME URINE STOOL INPUT OUT
PUT
T PR RR. BP T PR RR BP
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Bedside Nurse: __________________________

Charge Nurse: ____________________________
(To be signed by the Charge Nurse after plotting the information in the chart)

Clinical Instructor Clearance: _________________________

Received Copy: ____________________
NOTE: Must be submitted to the clinical instructor every
Received copy must be signed by the staff nurse on duty
Any ERASURE to any entry in the chart will mean a grade of 5
For the whole day and incident report with 24hrs hospital extension.