Staff in the neonatal intensive care unit (NICU) use this form during interdisciplinary rounds to document compliance with recommended care bundles (i.e., evidence-based recommended care interventions) and to indicate daily goals (based on patient acuity).

The left side of the tool ("System Status") is used to document the infant's status by system for the previous 24 hours. The right side of the tool ("Daily Goals and Plan") is used to document the plan of care and daily goals for the infant for the current day, following discussion and completion of the form by the interdisciplinary team.