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NYU SIMULATION HOSPITAL SBAR REPORT SHEET

Patient Name: ________________________________ MD/NP: _______________________________


Code: FULL PARTIAL DNR PALLIATIVE Allergies: _______________________________

S (Situation)
Diagnosis:

B (Background)
Past Medical History:

ISOLATION:

Contact

Droplet

Airborne

Immunocompromised

A (Assessment) Vital Signs: HR: _______ B/P ________ Resp ______ 02 sat % ________ on ____________ General Appearance: Cardiac: Respiratory: Gastrointestinal: Genitourinary: Extremities: Neurological: IV Access: Labs: Fall Risk : Pain: R (Recommendations)

Date:

Time:

RN Signature:

NYU SIMULATION HOSPITAL SBAR REPORT SHEET

Date:

Time:

RN Signature:

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