URGELLO STREET, CEBU CITY, PHILIPPINES 6000

+63 32 4188410 to 14

TEMPERATURE PULSE AND RESPIRATION RATE CHART

Patient Name: __________________________________________ Attending Physician: ________________________________________
Age: _______ Sex: _______ Room No. /Bed No. ___________ Hospital Unit No. ____________________________________________
Day of
Hospitalization
Post-Operative
Day No.
Date
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12

150 41

140 40
130
39
120
38
110
37

100 36

90 35

80

70 70

60 60

50 50

40 40

30 30

20

10

BLOOD PRESSEURE
6-2
2-10
STOOL 10-6
TOTAL
6-2
URINE 2-10
10-6
TOTAL
DOH-SWUMeD-NSD-F-007 Rev. 2