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FLOW SHEET

DATE:__________________________________
SECT. C.N.A. ASSIGNED ROOMS ( ) NOC ( ) DAY ( ) PM
1
2 NURSE CART
3 A
4 B
5 C
6 D
7 E
8 F
WEEKLY SUMMARIES

RESIDENT NAME VITALS

INTAKE & OUTPUT


RESIDENT NAME NURSE CNA TOTAL INTAKE TOTAL OUTPUT RESIDENT NAME NURSE CNA TOTAL INTAKE TOTAL OUTPUT

SEE REVERSE FOR DAILY CHARTING


FLOW SHEET

DAILY CHARTING

REASON RESIDENT NAME VITALS

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