BLOOD SUGAR MONITORING SHEET

NAME OF PATIENT: _______________________________ AGE: _________ SEX: _______

WARD: _______________________________ PHYSICIAN: _________________________

DATE TIME TAKEN CBS RESULT ACTION TAKEN

Effectivity Date: 03/04/2020 REV. No.: 01 GCGMH-F-NUR-08

This form is used for educational purposes only and with approval from the concerned agency. Strictly not for reproduction.
 DATE TIME TAKEN CBS RESULT ACTION TAKEN

Effectivity Date: 03/04/20220 REV. No.: 01 GCGMH-F-NUR-08

This form is used for educational purposes only and with approval from the concerned agency. Strictly not for reproduction.