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1. Situation
2. Background
3. Assessment
4. Recommendation

Pertinent information related to the situation

Can we get an order for a CBC?

Most recent vital signs

Clearly and briefly describe the current issue

I think he has an active GI bleed

I would like to get an EKG

Mr. Smith is having difficulty breathing

He is a 55 year old male who appears diaphoretic

My patient has a history of diabetes type 2

What is the nurse’s recommendation or what does he/she want

List of current medications, labs, allergies

Your assessment on the current situation

Hello Dr. ________, my name is _________

I think my patient has pneumonia and there is not a chest xray done

He was admitted for a GI bleed

I need for you to evaluate my patient right away