PT Room # Allergies: Chart Precautions: Code: Check off when charted Asses sment Plan of care Interventi ons

Assessment:
Neruo: Vitals Cardio: Temp Pulse Resp: Resp BP O2 stat GI: Pain Glucose GU: Check off when charted Meds:

Skin:

IV/Drains:

Hgb

WBC Hct

PLT

Na K+

Cl Ca

BUN glucose Cr

New orders:

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