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ICU Patient Monitoring Chart Template

This ICU chart contains fields to record key patient information and metrics over time, including vital signs, fluid intake and output, ventilator use, and clinical notes. It includes sections for patient identification data, dates of admission and discharge, responsible physician, bed number, and daily logs of temperature, pulse, respiratory rate, blood pressure, pupillary response, abdominal girth, Glasgow Coma Scale, central venous pressure, ventilator or oxygen use, and fluid intake and output amounts. The chart is designed for medical staff to efficiently document the patient's clinical status and progress during their ICU stay.

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SASIKUMAR S
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7K views2 pages

ICU Patient Monitoring Chart Template

This ICU chart contains fields to record key patient information and metrics over time, including vital signs, fluid intake and output, ventilator use, and clinical notes. It includes sections for patient identification data, dates of admission and discharge, responsible physician, bed number, and daily logs of temperature, pulse, respiratory rate, blood pressure, pupillary response, abdominal girth, Glasgow Coma Scale, central venous pressure, ventilator or oxygen use, and fluid intake and output amounts. The chart is designed for medical staff to efficiently document the patient's clinical status and progress during their ICU stay.

Uploaded by

SASIKUMAR S
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • ICU Chart
  • Intake and Output Chart

HOSPITAL LOGO

ICU CHART
PATIENT NAME : AGE : SEX : M / F IP NO: UHID

: DATE OF ADMISSION DATE OF DISCHARGE


DR NAME BED NO :

Date Pupils ABD VENTILATOR /


&Time TEMP PULSE R.R. B.P. SAQ
R L GIRTH
GCS CVP
MASK / TPIECE
Patient Name : Age: Gender : IP No: UHID:

INTAKE OUTPUT
Date IV FIUIDS Qty. Total Urine RT
Oral/NGF Drain Others Remarks
Time I [Link]. II [Link]. In ml. Intake Output Aisp

Signature

Total Intake ml.

Total output ml.


DON’T FILL THE COLOUMNS WITHOUT CHECKING

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