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Room #

VS
I&O
Hourly Safety Check
Gluc
Hygiene/Comfort Special Requests/Considerations/Precautions
7 _____ Brfst/O
7, 8, 9
___________________________________________
11 _____ Bathe, oral care
________ 11 _____ Lunch/O 11, 12, 13, 14
___________________________________________
15 _____ Supper/O 15, 16, 17, 18, 19
16 _____ Skin care, linen
___________________________________________
_____________________________________________________________________________________________________________________
7 _____ Brfst/O
7, 8, 9
___________________________________________
11 _____ Bathe, oral care
________ 11 _____ Lunch/O 11, 12, 13, 14
___________________________________________
15 _____ Supper/O 15, 16, 17, 18, 19
16 _____ Skin care, linen
___________________________________________
_____________________________________________________________________________________________________________________
7 _____ Brfst/O
7, 8, 9
___________________________________________
11 _____ Bathe, oral care
________ 11 _____ Lunch/O 11, 12, 13, 14
___________________________________________
15 _____ Supper/O 15, 16, 17, 18, 19
16 _____ Skin care, linen
___________________________________________
_____________________________________________________________________________________________________________________
7 _____ Brfst/O
7, 8, 9
___________________________________________
11 _____ Bathe, oral care
________ 11 _____ Lunch/O 11, 12, 13, 14
___________________________________________
15 _____ Supper/O 15, 16, 17, 18, 19
16 _____ Skin care, linen
___________________________________________
_____________________________________________________________________________________________________________________
7 _____ Brfst/O
7, 8, 9
___________________________________________
11 _____ Bathe, oral care
________ 11 _____ Lunch/O 11, 12, 13, 14
___________________________________________
15 _____ Supper/O 15, 16, 17, 18, 19
16 _____ Skin care, linen
___________________________________________
_____________________________________________________________________________________________________________________
7 _____ Brfst/O
7, 8, 9
___________________________________________
11 _____ Bathe, oral care
________ 11 _____ Lunch/O 11, 12, 13, 14
___________________________________________
15 _____ Supper/O 15, 16, 17, 18, 19
16 _____ Skin care, linen
___________________________________________

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