NURSING CLINICAL INITIAL NOTE – UCPHH

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Nursing Clinical Initial Note

Nursing Clinical Initial Note

"*" indicates required fields

MR Number:*

Last Name:

Visit Date:

MM slash DD slash YYYY

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Time

Hours

:

Minutes

AM/PM

Encounter Type (Visit):

Scheduled

PRN

Extra

Clinical Findings:

B/P:

..

Right

Left

Pulse:

..

AP

RP

Temperature:

Respiration:

Pulse:

on

Room Air

Oxygen

O2% sat:

Weight: (Kg/Lb)

Kg

Lb

Weight:

Blood Sugar:

FBS/RBS

FBS

RBS

FBS:

mg/dL

RBS:

mg/dL

Date of Last Doctor's Visit:

MM slash DD slash YYYY

Initial Note:

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