Name __________________________ Age _____ Room _________ MRN _________

__:__ T ____ P _______ BP _____/_____ R ____ SpO2 _____

__:__ T ____ P _______ BP _____/_____ R ____ SpO2 _____

prealb: ____ amy/lip: _______ Lact: ___

trop: ____ ____ ____
UA: _________________________

EKG: ______________________________________________

ISSUES:
MEDS:
Neuro/: __________________________ _________________________
Pulm: _____________________________ _________________________
CVS: ______________________________ _________________________
GI/PPX: ____________________________ _________________________
GU: _______________________________ _________________________
Vasc: ______________________________ _________________________
Ext: _______________________________ _________________________
FEN: ______________________________ _________________________
Endo: _____________________________ _________________________
ID: ________________________________ _________________________
Heme/coag: ________________________ _________________________
Other: _____________________________ _________________________
Lines: _______________________________________________________

Imaging: __/__
__/__
__/__
__/__
Consults: __/__
__/__
__/__
__/__
Cultures: __/__
__/__
__/__

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HPI: ________________________________________________________
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HTN DM MI CABG stent COPD asthma CKD

PMH: __________________________ ____________________________
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MEDS: __________________________ ____________________________
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SHx: ________________________________________________________
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FHx: __________________________ ____________________________
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SHx: __________________________ ____________________________
____________________________________________________________
Physical:
GEN:
Neuro:
PULM:
CVS:
ABD:
GU:
EXT: