MEDICAL RECORD REVIEW WORKSHEET
completed immediately following surgery and signed by surgeon R103) Tissue report on chart HOSP 3- CON’T. GENERAL MED/SURG AREA, ICU/CCU, GERI- PSYCH, DEATHS. Medical record number. Patient’s Name A0107) Admitting diagnosis A0027) Admitting Physician on staff A0106) H&P - 7 days prior or 48 hrs after admission A0112/A0113) Discharge summary ... ................
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