Patient’s Name: ____________________________________________ Case No: _____________

Ward/Bed No: _____________________________________________ Age/Sex: _____________

VITAL SIGNS MONITORING SHEET

Day of Month
Day of Disease
Day in Hospital
Weight
RR PR T
cpm bpm (OC)
42
41
40
180 39
170 38
160 37
150 36
140 35
130
120
110
100
60 90
50 80
40 70
30 60
20 50
10

URINE 7-3
OUTPUT 3-11
No. or ML 11-7
STOOL NO. 7-3
3-11
11-7
BLOOD PRESSURE