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REPUBLIC OF THE PHILIPPINES

PROVINCE OF SAMAR
BASEY DISTRICT HOSPITAL
BASEY SAMAR

NURSES DAILY WARD CENSUS


Date: _______________
1.

Ward: ___________

Remaining from yesterdays midnight census: _________


Hosp #

A.

Ward/Rm #

Name of Patient

Sex

Age

Time

Admission

2. TOTAL ADM.

_____

B. Transfer-in from
other area

3. TOTAL
TRANSFER IN

_____

C. Births

4. TOTAL BIRTHS

_____

D. Discharges

6. TOTAL
DISCHARGES

_____

E. Referral to Higher
Institution

7. TOTAL
REFERRALS

_____

F. Death
8. TOTAL DEATHS

_____

5. Total of # 1, 2, 3 & 4 = __________


9. Total of # 6, 7, 8 = ______________

10. Remaining census @ 12 midnight (#5) minus (#9) = __________

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