Signout / Handoff Note

Patient 1: [Name], Bed __

• One-line:* [Age], [sex], HD#___, with [diagnosis]

• Current status:* (stable / tenuous / critical)

• Active issues:*

1. 2.

• Anticipated events / tasks for night:*
• Follow up cultures:
• Repeat labs at ___:
• Check for extubation readiness:
• Family discussion:
• Other:

• If/then:*
• If BP drops below ___, then:
• If temp spikes, then:
• If patient becomes more agitated, then:

• Code status:* (Full / DNR-CCA — discussion held with family by ___)

• Anticipated admissions:*
• (Trauma bay, ED, OR — brief summary)

• This signout is not a clinical note and does not replace documentation in the medical record.*