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Daily Report
Patients Name
Patients ID
Care Giver Name
Date
Vital Signs
Pulse Rate
Time
Bpm
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Respiration Rate
Time
pm
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Blood Pressure
Time
Systole
(mm of hg)
Daistole
(mm of hg)
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Body Temperature
Time
"F
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Daily Output
Stool Output
Time
Type & color
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Urine Output
Time
ml
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Daily Intake
Water Intake
Time
ml
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Food Intake
Time
Nature
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Other
Other Essencials
Time
mg/dl
FBS
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PPBS
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RBS
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Dressing
Time
Type
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Special Instruction