RM # NAME: AGE: MD: CODE: FULL DNR DNL
ADMIT : DX: PMH: Allergies:
IV SITE: Activity: NG V/S T HR RR B/P O2
BR UTC Ad Lib
JP 0700
BSC BP
Total G/J Tube 1100
assist
1600
Dressing: self Trach #
Hx
LABS: AM LABS: Isolation D/C Meds REC
CDIFF Home Inst Vaccines
D/C IV RX FSBS: Q: HX
MRSA
Sign chart Care plan
Critical to MD VRE Pearls
Neuro AAO x Speech: C S A Cardio: Tele: Cap Refill Edema O2 Lung Sounds Cough
MAE RUE RLE ULE LLE
Tingling Numbness Weakness
Pupils R: mm B /S/ NR/F L: mm B /S/ NR /F
Skin/Wound GI Diet: BS: GU URINE
Last BM: / VOO FOLEY CATH
Pain/MEDS MEDS
FSBS Passport
NPO Consent
CONSULTS: PT OT SP Dietician OFF UNIT
I/O’s Pre-Op
Procedures/Reports (chart in MISC notes) Antibx IVPK Input
1X Dose IV SITE Change
Screen MRI MRSA CTSCAN
X&Type Blood FFP PLTS
Chart Amt I/O’s F/U H/H
Wound Care
Neuro Checks
PCA PUMP 0800 1000 1200 1400 1600 1800
Stroke Packet CHF
VTBI
Bolus PEARLS/PT ED
Specimen
Attempts
Delivery PPD
Drains-
Other-