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ROOM # NAME: AGE: GENDER: DIET: DOA:

CRP #: FILE #: PIC: ADMITTING DIAGNOSIS:

ROUTINE MEDICATIONS ENDORSEMENT / NEW ORDERS / SPECIAL NOTES (DATE:______________________)


SHOWER BOWEL
DATE DRUG NAME/DOSE/ROUTE FREQUENCY

PRN /STAT MEDS VITALS

DATE/TIME BP HR TMP SP02 FBS WT ADM PROCEDURE


ECG: LAB:

HGT: WT:

DRUG TEST:

BREATHANALYZER:

ROOM # NAME: AGE: GENDER: DIET: DOA:

CRP #: FILE #: PIC: ADMITTING DIAGNOSIS:

ROUTINE MEDICATIONS ENDORSEMENT / NEW ORDERS / SPECIAL NOTES (DATE:______________________)


SHOWER BOWEL
DATE DRUG NAME/DOSE/ROUTE FREQUENCY

PRN /STAT MEDS VITALS

DATE/TIME BP HR TMP SP02 FBS WT ADM PROCEDURE


ECG: LAB:

HGT: WT:

DRUG TEST:

BREATHANALYZER: