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MEDIDAS MEDICAL CLINIC

VALENCIA CITY, BUKIDNON


24 HOURS REPORT SHEET
12:00 AM __________ 12:00 AM _________
No. of Units ________ No. of Units ________
Patients: ____________ Patients: ___________
ADMISSIONS:
WARD or CLASSIFICATION NAME OF PATIENT CONDITION MEMBERSHIP TIME
ROOM NO.

DISCHARGED:
WARD or CLASSIFICATION NAME OF PATIENT TIME
Room no. CONDITION MEMBERSHIP

TRANSFER FROM WARD/RM NO. TO WARD/RM NO. NAME OF PATIENT TIME


_________________________ ________________________ ___________________________ __________
_________________________ ________________________ ___________________________ __________

DEATHS WARD/RM NO. UNDER 24 HOURS UNDER 23 HOURS TIME


_________________________ _________________________ ___________________________ __________
_________________________ _________________________ ___________________________ __________
BIRTHS: NAME OF BABY NAME OF MOTHER TIME
________________________ ______________________________________________________ __________
________________________ ______________________________________________________ __________

PERSONNEL. 7AM-7PM SHIFT NUMBER REMARKS TIME


Charged nurse: __________________________ ___________________ ______________________ _________
Staff nurse: _____________________________ ___________________ _______________________ _________
Attendant: ______________________________ ___________________ _______________________ _________
No. of Beds: ____________________________ ___________________ _______________________ _________
Vacant Beds: ___________________________ ____________________ _______________________ _________
Additional Emergency beds used: ______________
_______________________
Signature of Charged Nurse

PERSONNEL: 7PM._ 7AM SHIFT NUMBER REMARKS

Head Nurse: _______________________________ __________________ ____________________________


Staff Nurse: _______________________________ __________________ _____________________________
Attendant: ________________________________ __________________ _____________________________
No. of Beds: ______________________________ __________________ _____________________________
Vacant beds: ______________________________ __________________ ____________________________
Additional Emergency Beds Used: ______________
________________________
Signature of Charged Nurse
CLASSIFICATION OF SERVICES
MEDICALS OLD_________________
NEW_________________ TOTAL _____________
PEDIA OLD _________________
NEW_________________ TOTAL_____________
ADULT OLD__________________
NEW_________________ TOTAL_____________
GYNECOLOGY OLD__________________
NEW__________________ TOTAL_____________
NEWBORN OLD__________________
NEW_________________ TOTAL_____________
PEDIA FROM NURSERY OLD__________________ TOTAL_____________
NEW_________________ TOTAL_____________
PEDIA FROM OUTSIDE OLD_________________ TOTAL_____________
NEW_________________ TOTAL_____________
TOTAL PATIENTS ________________________
TOTAL FREE PATIENTS ________________________
GRAND TOTAL ________________________
TOTAL ADMISSIONS ________________________
TOTAL DISCHARGES ________________________
TRANSFERRED OUT ________________________
TRANSFERRED IN ________________________
DEATHS _______________________

IMPORTANT: THIS REPORT MUST BE COMPLETED AND SEND


TO THE OFFICE OF THE CHIEF NURSE EVERY
MORNING AT 8:00 AM.