HOLY ANGEL UNIVERSITY

Holy Angel University Sto. Rosario St. Santo Rosario St, Angeles, Pampanga
College of Nursing and Allied Medical Sciences
ENDORSEMENT SHEET
Area:
Date:
Clinical Instructor:

Student’s Name:
Patient’s Name:
Room No:
Age:
Chief Complaint:
Diagnosis:
Vital Signs: TIME TIME TIME
 T:  T:  T:  T:
 BP:  BP:  BP:  BP:
 PR:  PR:  PR:  PR:
 RR:  RR:  RR:  RR:
 O2 SAT:  O2:  O2:  O2:
IV Therapy:
 Solution:  Solution:  Solution:  Solution:
 Rate:  Rate:  Rate:  Rate:
 Bott. No.:  Bott. No.:  Bott. No.:  Bott. No.:
 Level:  Level:  Level:  Level:
Intake-Output:
 I:  I:  I:  I:
 O:  O:  O:  O:
Lab Procedures:
Medications:

Notes:

Doctor’s Order: