Free Physician SBAR Template
Physician SBAR
Prepared by: [Your Name]
[Your Company Name], [Your Department]
Date: [DATE]
SITUATION |
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|---|---|
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PATIENT NAME: |
[PATIENT'S NAME] |
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AGE: |
[PATIENT'S AGE] |
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ROOM NUMBER: |
[ROOM NUMBER] |
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PRIMARY PHYSICIAN: |
[PRIMARY PHYSICIAN'S NAME] |
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SPECIALIST/CONSULTANT: |
[SPECIALIST OR CONSULTANT'S NAME] |
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DATE/TIME OF CONSULT: |
[DATE AND TIME OF CONSULTATION] |
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REASON FOR CONSULT: |
[REASON FOR CONSULTING OR TRANSFERRING PATIENT CARE] |
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CURRENT CONDITION: |
[BRIEF SUMMARY OF PATIENT'S CURRENT CONDITION] |
BACKGROUND |
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|---|---|
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MEDICAL HISTORY: |
[BRIEF OVERVIEW OF PATIENT'S MEDICAL HISTORY] |
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ALLERGIES: |
[LIST OF KNOWN ALLERGIES] |
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CURRENT MEDICATIONS: |
[LIST OF CURRENT MEDICATIONS AND DOSAGES] |
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RECENT PROCEDURES: |
[RECENT PROCEDURES UNDERGONE BY THE PATIENT] |
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FAMILY INFORMATION: |
[INFORMATION ABOUT FAMILY INVOLVEMENT AND SUPPORT] |
ASSESSMENT |
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|---|---|
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PRIMARY PHYSICIAN'S ASSESSMENT: |
[ASSESSMENT FINDINGS BY THE PRIMARY PHYSICIAN] |
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SPECIALIST'S ASSESSMENT: |
[ASSESSMENT FINDINGS BY THE SPECIALIST OR CONSULTANT] |
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CURRENT SYMPTOMS: |
[LIST OF CURRENT SYMPTOMS OBSERVED] |
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DIAGNOSTIC FINDINGS: |
[SUMMARY OF DIAGNOSTIC FINDINGS] |
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CURRENT VITAL SIGNS: |
[CURRENT VITAL SIGNS OF THE PATIENT] |
RECOMMENDATION |
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|---|---|
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SPECIALIST'S RECOMMENDATIONS: |
[RECOMMENDATIONS PROVIDED BY THE SPECIALIST] |
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TREATMENT PLAN: |
[PROPOSED TREATMENT PLAN FOR THE PATIENT] |
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FOLLOW-UP INSTRUCTIONS: |
[INSTRUCTIONS FOR FOLLOW-UP CARE OR MONITORING] |
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PATIENT TRANSFER: |
[INSTRUCTIONS OR PLANS FOR TRANSFERRING PATIENT CARE, IF APPLICABLE] |
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QUESTIONS/CONCERNS: |
[ANY QUESTIONS OR CONCERNS TO ADDRESS] |
