S Pt Info

Room

Code Status Care Team
Isolation

Allergies
C/O 1
st
Dx 2
nd
Dx

B History Surgeries





Fall Level PU Risk

Core Measures


Prophylaxis
GI
DVT
Vaccines: PNA / FLU
Precautions
A Neurological Checks WNL



GI PEG NGT Ostomy LBM ______ WNL



Diet NPO


Cardiovascular Daily Wt WNL


EKG
GU FOLEY WNL

Intake Output
Respiratory BIPAP/CPAP Trach WNL



Ortho WNL Mobility/Activity Endocrine/Accuchek
Skin/Wounds/Wound Care/PU WNL










IVT/Drips
`


Labs




Diagnostics To Collect
Medications







PRN Pain/N&V/BP T
BP
HR
O2
RR
ICU Protocols

Issues/Family Members



Personal Equipment
R Notes/To do









Transfer/Discharge Plans