Duration of this problem: ________________________________________________________
Name of Operation:______________________________________________________________
| Pre-Operation: Time: _____________________ |
| Temp: |
Pulse: / Min |
BP: / mmHg |
SPO2: % |
| Intra-Operation: Time: _____________________ |
| Temp: |
Pulse: / Min |
BP: / mmHg |
SPO2: % |
| Post-Operation: Time: _____________________ |
| Temp: |
Pulse: / Min |
BP: / mmHg |
SPO2: % |
Name & Signature of Nurse: ______________________________________________
Date & Time: _____________________________________________________________
…………………………………………………………………………………………………
Nursing Notes : Fit to discharge from OT (Yes / No)
Condition of Patient on Discharges: ________________________________________
Name & Signature of Nurse: ______________________________________________
Date & Time: _____________________________________________________________