Far Eastern University

Institute of Nursing

VITAL SIGN AND INPUT AND OUTPUT SHEET

Student Nurse: _____________________________________________________ Date: _________________
Patient’s Name/ Bed Number/ T BP P T RR O2 INPUT OUTPUT
Room Number SAT ORAL IV NGT OTHERS U S D OTHERS
7
8
9
10
11
12
1
2
3
4
TOTAL
7
8
9
10
11
12
1
2
3
4
TOTAL
7
8
9
10
11
12
1
2
3
4
TOTAL
 Far Eastern University
Institute of Nursing

ENDORSEMENT SHEET
Student Nurse: _____________________________________________________ Date: _________________

Patient’s Name /Bed and Age Sex Diagnosis IVF Diet Contraption Remarks
Room Number
 Far Eastern University
Institute of Nursing

MEDICATION SHEET
Student Nurse: _____________________________________________________

Patient’s Name /Bed and Room Number MEDICATION

TIV Time Oral Time