PATIENT’S RECORD

Patient’s Name: __________________________________________________________________________

Address: ________________________________________ Birthdate: ___________ Gender: _________________

Philhealth No. __________________ Civil Status: __________________ NHTS Non-NHTS

DATE/ AGE VITAL SIGNS CHIEF COMPLAIN NURSE’S NOTES/ TREATMENT

PLAN

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WT: PR:
T: O2:

HT: BP:
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T: O2:

HT: BP:
WT: PR:
T: O2:

HT: BP:
WT: PR:
T: O2:

BARANGAY TAPI
 HT: BP:
WT: PR:
T: O2:

BARANGAY TAPI
BARANGAY TAPI