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Shift: ____________

Date:_________
Head Nurse for the day: ___________________

Name and room of patient

Endorsement Sheet
BP
RR
HR/P Temp
R

DX

IV

I/O

Name:

I:

I:

I:

I:

U:

Room:
Name:

F:
I:

F:
I:

F:
I:

F:
I:

S:
U:

Room:
Name:

F:
I:

F:
I:

F:
I:

F:
I:

S:
U:

Room:
Name:

F:
I:

F:
I:

F:
I:

F:
I:

S:
U:

Room:
Name:

F:
I:

F:
I:

F:
I:

F:
I:

S:
U:

Room:
Name:

F:
I:

F:
I:

F:
I:

F:
I:

S:
U:

Room:

F:

F:

F:

F:

S:

Medications

Name:

I:

I:

I:

I:

U:

Room:

F:

F:

F:

F:

S:

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