Serving the Phoenix Area & Beyond After Hours Phone No: 602-562-9059

Employee Patient Balance Form

This form is to be completed each Friday afternoon, to help us track whether we should be focusing on getting more patients, more nurses, or both.

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Date (this should be the Friday of the week being reported)*
MM slash DD slash YYYY
Total Number of Patients
Number of New Patients This Week
Number of Patients Lost This Week
Total Number of RNs
Total Number of RN Hours Needed
Ideally, how many hours of RN scheduling would you have liked to have this week in order to properly serve the patients?
Total Number of RN Hours Worked
How many hours were we able to assign an RN to work those desired hours?
Total Number of CNAs
Total Number of CNA Hours Needed
Ideally, how many hours of CNA scheduling would you have liked to have this week in order to properly serve the patients?
Total Number of CNA Hours Worked
How many hours were we able to assign an CNA to work those desired hours?