RM # NAME: AGE: MD: CODE: FULL DNR DNL

ADMIT : DX: PMH: Allergies:

IV SITE: Activity: NG V/S T HR RR B/P O2

BR UTC Ad Lib
JP 0700
BSC BP
Total G/J Tube 1100
assist
1600
Dressing: self Trach #
LABS: AM LABS: Isolation D/C Meds REC Hx
CDIFF Home Inst Vaccines
D/C IV RX FSBS: Q: HX
MRSA
Sign chart Care plan
Critical to MD VRE Pearls

Neuro AAO x Speech: C S A Cardio: Tele: Cap Refill Edema O2 Lung Sounds Cough

MAE RUE RLE ULE LLE

Tingling Numbness Weakness
Pupils R: mm B /S/ NR/F L: mm B /S/ NR /F
Skin/Wound GI Diet: BS: GU URINE

Last BM: / VOO FOLEY CATH

Pain/MEDS MEDS
FSBS Passport

NPO Consent

CONSULTS: PT OT SP Dietician OFF UNIT

I/Os Pre-Op

Procedures/Reports (chart in MISC notes) Antibx IVPK Input

1X Dose IV SITE Change

Screen MRI MRSA CTSCAN

X&Type Blood FFP PLTS

Chart Amt I/Os F/U H/H

Wound Care

Neuro Checks
PCA PUMP 0800 1000 1200 1400 1600 1800
VTBI Stroke Packet CHF
Bolus
Attempts PEARLS/PT ED
Specimen
Delivery
PPD

Drains-

Other-