Accucare Nursing & Home Care — School Clinical Record

Accucare Nursing & Home Care — School Clinical Record

Complete one form per nurse, per patient, per shift (including shifts with no medications or events).
Section A — Patient & Assignment
Patient Initials
Enter patient initials only
Date of Birth

MonthDayYear
Date
Known Allergies
Patient Care Type — select all that apply
Date of Service

MonthDayYear
Date
Setting
School / District
Bus Route #
Supervisor Name
Nurse Email
example@example.com
Nurse Phone
Please enter a valid phone number.Format: (000) 000-0000.
Nurse Name
Credential
Shift Start

Hour Minutes

AM/PM Option
Shift End

Hour Minutes

AM/PM Option
Section B — Pre-Shift Verification
Complete every shift
Section C — Medication Administration Record
Record every medication administered, including all PRN and emergency rescue medications.
Medication Entries
Section D — Clinical / Emergency Event Record
Record any seizure, acute change, injury, or emergency response. For seizures, note type and duration.
Clinical / Emergency Event Entries
Diabetic — Blood Glucose & Insulin Log
Log every blood glucose check and every insulin dose. If a reading is outside the physician-ordered parameters, record it immediately, note the action taken, and document who was notified and when.
Diabetic Log Entries
Diabetic Log Entries
Diabetic Log Entries
G-Tube Log
Log feedings, flushes, tube-site checks, and any issues.
G-Tube Log Entries
Date/Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Section E — Notes / Supervisor Contact
Attachment

Optional: attach a photo or document such as a paper log, seizure timing notes, or an incident photo.
Cancelof
Event Description (type, duration)
Intervention
Outcome / Response
911?
Section F — Nurse Attestation
Signature
Print Name
Date

MonthDayYear
Date
Should be Empty:

Accucare Nursing & Home Care — School Clinical Record

Section A — Patient & Assignment

Section B — Pre-Shift Verification

Section C — Medication Administration Record

Section D — Clinical / Emergency Event Record

Diabetic — Blood Glucose & Insulin Log

G-Tube Log

Section E — Notes / Supervisor Contact

Section F — Nurse Attestation