SBAR Report to Physician About a Critical Situation

Rochester District VNA Tele # 603-332-1133 Fax # 603-332-9223 SBAR report to physician about a patient situation Situation (Briefly state the problem) S PATIENT NAME: PHYSICIAN: DATE:

Vital signs are: Blood pressure / , Pulse , Respiration ,Temperature , Blood Sugar , Pulse Oximeter , Current O2/L

Current Situation: SEE ATTACHED HISTORY OF VITALS B Background (Information related to the situation) Pertinent Medical Diagnoses:

Current Medications: (Medications that may be affecting situation)

What has been done up to this point:

Assessment A This is what I think the problem is: R Recommendation I suggest: (Include when clinician will f/u):

Comments:

I have just assessed the patient personally: Reporting Clinician:

CALL OR FAX RDVNA’S INTAKE DEPARTMENT WITH FURTHER PLANS AND ORDERS MD ORDERS: (PLEASE RESPOND WITHIN 24HRS)