Name:
| | |
|Name: |Name: |
| | |
|Room: |Room: |
| | |
|Code Status: |Code Status: |
|Age: |Age: |
| | |
|Admit Date: |Admit Date: |
|MD: |MD: |
| | |
|Diagnosis: |Diagnosis: |
| | |
|History: |History: |
| | |
|Allergies: |Allergies: |
| | |
|Diet: |Diet: |
|Activity Level: |Activity Level: |
| | |
|Weight: |Weight: |
|I/O Monitoring: |I/O Monitoring: |
| | |
|Special Needs / Precautions: |Special Needs / Precautions: |
| | |
|Head to Toe Assessment Abnormalities: |Head to Toe Assessment Abnormalities: |
| | |
|IVs, Catheters, Suction/Feeding Tubes (type/location): |IVs, Catheters, Suction/Feeding Tubes (type/location): |
| | |
|Date(s) Inserted: |Date(s) Inserted: |
| | |
|IV Fluids: |IV Fluids: |
| | |
|Scheduled Labs/Procedures: |Scheduled Labs/Procedures: |
| | |
|Meds & VS Schedule: |Meds & VS Schedule: |
| | |
|0800 |0800 |
| | |
| | |
|0900 |0900 |
| | |
| | |
|1000 |1000 |
| | |
| | |
|1100 |1100 |
| | |
| | |
|1200 |1200 |
| | |
| | |
|1300 |1300 |
| | |
| | |
|1400 |1400 |
| | |
| | |
|1500 |1500 |
| | |
| | |
|1600 |1600 |
| | |
| | |
|1700 |1700 |
| | |
| | |
|1800 |1800 |
| | |
| | |
|PRN Meds: |PRN Meds: |
| | |
| | |
|Miscellaneous (consults, discharge plans, etc.): |Miscellaneous (consults, discharge plans, etc.): |
| | |
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