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PATIENT IDENTIFICATION

RECORD OF WEIGHT, VITAL SIGNS AND Name of patient


GENERAL FLOW SHEET
State Form 46318 (R / 9-01) ID number

Date of birth (month, day, year)

INITIALS
RECORDER IDENTIFICATION
BLOOD REPETITIVE ITEMS TO BE RECORDED
DATE TIME WT. T P R (record only once per page)
PRESSURE (initial each entry)
SIGNATURE AND TITLE

Refer to Progress Notes for assessment.

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