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Name/Age/Room # Code Status M.D.

Admit Date Diagnosis History

Name/Age/Room # Code Status M.D. Admit Date Diagnosis History

Allergies Weight Diet Activity Level Precautions IV, Tubes - Locations, Date Inserted

Allergies Weight Diet Activity Level Precautions IV, Tubes - Locations, Date Inserted

IV Fluids Labs/Procedures

IV Fluids Labs/Procedures

Medication and Vital Sign Schedule 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 Assessment/Miscellaneous 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200

Medication and Vital Sign Schedule

Assessment/Miscellaneous

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