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ENDORSEMENT SHEET

WARD: ____________BED NO. _________________


PATIENTS NAME: ________________________________________________________ AGE: _____________
DATE OF ADMISSION: _____________________________________________________SEX:_____________
CHIEF COMPLAINT: _______________________________________________________WEIGHT__________
ADMITTING DIAGNOSIS: _____________________________________________________________________

IV FLUIDS ORAL MEDS / NEBULIZATION DIET

LABS

IV MEDICATIONS

X-RAY/ UTZ

VITAL SIGNS
DATE
SHIFT
BP
TEMP
PR
RR

DATE REMARKS
SHIFT
BP
TEMP
PR
RR
INPUT / OUTPUT
DATE
SHIFT
URINE
VOMITING
STOOL

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