SURIGAO DOCTORS’ HOSPITAL, INC.

Sitio Kinabutan, Brgy. Rizal, Surigao City

“A Hospital with a Heart”
HOSPITAL DAILY CENSUS REPORT
Date: Ward/Unit:
ADMISSION DISCHARGE
CASE ROO CASE ROO
CLASSIFICATION
PATIENT’S NAME AGE TIME CLASSIFICATION
PATIENT’S NAME AGE
NO.: M NO.: M
NO.: NO.:

TRANSFER IN TRANSFER OUT

CASE FROM TIME AGE
CLASSIFICATION CASE TO TIME PATIENT’S NAME AGE
NO.: NO.:
PATIENT’S NAME

DEATH
CASE PATIENT’S NAME AGE CLASSIFICATION
TIME CASE PATIENT’S NAME AGE CLASSIFICATION

NO.: NO.:

CENSUS SUMMARY FOR THE DAY

1. Remaining from yesterday’s midnight report…………………._________________________
2. Admissions…………………………………………………………………….._________________________
3. Total of no. 1, 2………………………………………………………………_________________________
4. Discharges (alive) the census day………………………………….._________________________
5. Death……………………………………………………………………………._________________________
6. Total of 4, 5…………………………………………………………………..__________________________
7. Remaining at 12:00 midnight [ (3) minus (6) ]……………….__________________________
8. Admitted and discharged on same day…………………………__________________________
9. Total in-patient service days of care [ (7) plus (8)…………__________________________