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INTRO

ROOM #

AGE

SEX

FLOOR

NOTES

DIAGNOSIS

VITALS

PATIENT
CHIEF COMPLAINT/WHAT BROUGHT THE PATIENT IN

SYMPTOMS

ASSESSMENT
CODE STATUS

DIET

OXYGEN/IVS/TUBES/OSTEMY

RESPONSE TO TX/WHAT IS YET TO BE KNOWN

CRITICAL LABS

ALERTS/AMBULATION

ALLERGIES

CO-MORBIDITIES

HX/FAM HX/PREVIOUS EPISODES

MEDICATIONS

SITUATION

SAFETY

BACKGROUND

ACTIONS
PRIORITIZATION OF ACTIONS/URGENCY
TIMING
CURRENT PHYSICIAN, FAMILY CONTACT, NURSE
OWNERSHIP
PLAN/CHANGES/WHAT WILL HAPPEN NEXT
NEXT

NOTES/FINANCIAL

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