DESERT WILLOW TREATMENT CENTER
DIVISION OF CHILD AND FAMILY SERVICES
|NAME: | |
|ADMISSION DATE/TIME: | A.M. P.M. |
|DIAGNOSIS: | |
|DOB: | |
|ALLERGIES: | |
ADMISSION:
Sedona Residential Sunrise Residential SATP Residential COD Residential
LABS:
| Comprehensive Metabolic Panel | | Urine Drug Screen |
|Lipid Panel | |HIV-1 AB Screen w/ reflex |
|CBC w Diff w Platelet Ct | |PPD |
|Pregnancy, HCG Total Quant | |TSH |
|Urinalysis | |Chlamydia Trachomitis DNA Amplified |
Other
PRECAUTIONS:
Routine q 15-min checks 1:1 SP I SP II
Seizures AWOL Building Restriction
Other
Diet: Regular
Therapy: Individual, Family: THERAPIST:
VS: Admission and q week
WT lbs on admission and q week
HT ' " on admission and q monthly
Physical Exam
Lice Check, Call M.D. if (
Other
MEDICATIONS:
Tylenol 650 mg T q 4 hrs PRN Pain or Fever – Not To Exceed 2 doses in 24º OR
Ibuprofen 400 mg T q 4 hrs PRN Menstrual Cramps or Pain – Not To Exceed 2 doses in 24º
Maalox 30 ml po q 4 hrs PRN Upset Stomach – Not To Exceed 2 doses in 24º
MOM 30 ml q bedtime PRN Constipation
JUSTIFICATION FOR 2 OR MORE ANTIPSYCHOTIC MEDICATIONS PRESCRIBED:
A.M. P.M.
Date Time
M.D. M.D.
Physician Print Name Physician Signature
Witness Signature Date Parent / Legal Custodian Signature Date
VO TO RB/V
Patient Name Patient SS #
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Desert Willow Treatment Center
ADMISSION ORDERS
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