Hospital Checklist to Improve Staff Coordination
Student’s Name
Institution
Hospital Checklist to Improve Staff Coordination
1. Admission
Name of Admitting officer:
………………………………………………………….
Date of Admission: ………………………………
Age of patient
Gender; tick as appropriate
MaleFemale
Complaints:
……………………………………………………………………………………………………………………………………….
Blood Pressure: ………………………………….
Patient History
Prior Illnesses: ……………………………………………………………………………………………………………………………………….
Prior Diagnoses: ……………………………………………………………………………………………………………………………………….
Illness status:
Acute Bad
Ward Admitted to: ……………………….
Sign
2. Treatment:
Name of Checking Officer:
…………………………………………………………………
Do you confirm having confer with the Admission Details
YesNo
Patient Status:
AcuteBadFairly ill
Diagnosis
……………………………………………………………………………………………………………………………………………………………………………………………………………
Medical Recommendations
…………………………………………………………………………………………………………………………………………………………………………………………………………….
Information communicated to Patient
…………………………………………………………………………………………………………………………………………………………………………………………………..
Patient Response to treatment:
……………………………………………………………………………………………………………………………………………………………………………………………………..
Sign: ____________
3. Pharmaceutical Check
Name of Checking Officer:
……………………………………………………………………………………………………………………………………….
Do you confer having read the valuations and recommendations of the previous officers:
yes no
Do you agree with recommendations
If no, then why? ………………………………………………………………………………………………………………………………………
If you do not agree, please confirm communicating to the officer concerned:
YesNo
Recommendations;
………………………………………………………………………………………………………………………………………………………………………………………..
Patient Response to medical dosage:
…………………………………………………………………………………………………………………………………………………………………………..
Sign
4. Care:
Name of caring officer:
…………………………………………………………………………………………………………………………………………
Please confirm having read all the recommendations and evaluations of the previous officer:
Further Recommendations:
……………………………………………………………………………………………………………………………………………………………………………………………………….
Information communicated to patient:
……………………………………………………………………………………………………………………………………………………………………………………………………..
Patient Response to care:
…………………………………………………………………………………………………………………………………………………………………………………………..
4. Discharge:
Discharging officer
………………………………………………………………………………………………………………………………………..
Do you confirm having read the recommendations and evaluation of the previous officers?
YesNo
Patient Status
ImprovedNo improvement
Evaluation/ Recommendations:
……………………………………………………………………………………………………………………………………………………..
Reason for Discharge:
ImprovedReferred
Information Communicated to Patient
Medical Bill: ……………………………………………..
(Please tick as appropriate)
ClearedNot cleared
Sign: ……………………
Date of discharge: ………………………….
