Hospital Daily Census Report
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(For non-departmentalized hospital)
__________________________________________ (Name of Hospital) __________________________________________ (Address)
HOSPITAL DAILY CENSUS REPORT Service ______________________________
Floor/ Section _______________________
For the 24- hour ended midnight of: Date ______________________ ADMISSIONS Hospital Room no. no.
Patient’s Name
Time
Hospital no.
DISCHARGES Room Patient’s Name no.
Time
DEATHS
CENSUS SUMMARRY FOR THE DAY 1. Reamaining from yesterday’s midnight report. . . . . . . . . . . . . . . . . . . . _______________________ 2. Admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 3. Total of No. 1, 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 4. Disharges (Alive) this census day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 5. Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 6 Total of 4, 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 7 Remaining at 12:00 midnight [ (3) minus (6) ] . . . . . . . . . . . . . . . . . . . . _______________________ 8. Admitted and discharged on same day. . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 9. Total in-patient service days of care [(7) plus (8) . . . . . . . . . . . . . . . . . . _______________________
__________________________________________ (Name of Hospital) __________________________________________ (Address)
HOSPITAL DAILY CENSUS REPORT Service ______________________________
Floor/ Section _______________________
For the 24- hour ended midnight of: Date ______________________ ADMISSIONS Hospital Room no. no.
Patient’s Name
Time
Hospital no.
DISCHARGES Room Patient’s Name no.
Time
DEATHS
CENSUS SUMMARRY FOR THE DAY 1. Reamaining from yesterday’s midnight report. . . . . . . . . . . . . . . . . . . . _______________________ 2. Admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 3. Total of No. 1, 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 4. Disharges (Alive) this census day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 5. Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 6 Total of 4, 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 7 Remaining at 12:00 midnight [ (3) minus (6) ] . . . . . . . . . . . . . . . . . . . . _______________________ 8. Admitted and discharged on same day. . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ 9. Total in-patient service days of care [(7) plus (8) . . . . . . . . . . . . . . . . . . _______________________
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