ICU Nurse Report

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This template was officially written/prepared/created by: [Your Name]

I. Patient Information

Patient Name:	Josephine Smith
Age:	75
Gender:	Female
Admission Date:	January 15, 2050
Emergency Contact:	Brandon Jones
Relation:	Son
Phone:	[phone number]

II. Medical History

Past Medical Conditions

• Hypertension

• Diabetes

• Coronary Artery Disease

Allergies

• Penicillin

• Sulfa Drugs

III. Current Condition

Vital Signs

Parameter	Value	Unit
Temperature	98.6	°F
Heart Rate	80	bpm
Blood Pressure	120/80	mmHg

Medications

• Medication 1: Lisinopril - 10 mg daily

• Medication 2: Metformin - 500 mg twice daily

IV. Treatment Plan

Current Interventions

• Intubation

• IV Fluids

• Oxygen Therapy

Future Interventions

• Daily Blood Tests

• CT Scan scheduled for January 20, 2050

V. Nurse Notes

Date	Time	Notes	Nurse Name
January 15, 2050	08:00 AM	Admitted to ICU; intubated	Mary Smith
January 16, 2050	08:00 AM	Stable overnight; no complications	Susan Clark

VI. Contact Details

• Email: [Your Company Email]

• Phone: [Your Company Number]

• Website: [Your Company Website]

• Social Media: [Your Company Social Media]

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