PATIENT’S RECORD

Case Number 2021- IV003 Patient ID 2021-003

Name: Age: Date of Birth: Place of Birth: ISPH-GS, Category of

Patient:
Andude, Cleopatra 36 01/01/1985 Vigan City, Ilocos Sur
Philhealth

Home Address: Sex: Civil Status: Religion: Nationality:

Roman
8 Rivero St. Brgy. IX, Vigan City, Ilocos Sur Female Married Catholic Filipino

Next of Kin: Relationship: Address: 8 Rivero St. Brgy. IX, Contact No.:
Vigan City, Ilocos Sur
Andude, Ka Husband

Date Admitted: Time: Date of Discharge: Time: No. of Hospital Days:

October 25, 2021 __8_____ ________

A.M. A.M.

________ ________
P.M. P.M.

Ward: Attending Physician: Admitting Nurse:

OBWARD-123 Dr. Danilo Dizon Renea Joy M. Arruejo

ADMITTING DIAGNOSIS:

R/0 PTB BT, chemically induced Acute Kidney Infection; Ovarian CA

FINAL DIAGNOSIS: ICD 10 Code:

Acute Kidney Infection N17.9

Condition on Discharge: Disposition:

[ ] recovered [ ] died [ ] discharged [ ] absconded

[ ] improved [ ] autopsied [ ] transferred [ ] referred to OPD

[ ] unimproved [ ] not autopsied [ ] home against for follow up advice

COMPLICATIONS:
 OPERATION/PROCEDURE DONE:

Review for completeness:

dizondanilo juneaprilmay

___________DANILO DIZON________________ _____________APRIL MAY JUNE_______________

Signature over Printed Name Signature over Printed Name

of Attending Physician (Record Officer)

PARENTERAL SHEET
Name:_Andude, Cleopatra_____________________Age_36_Sex: Female CS:_Married_Ward/Room:
OBWARD-123
Attending Physician:_Dr. Danilo
Dizon_______________________________________________________________

BOTTLE SOLUTION, VOLUME.

NO. REMARKS Time REMARKS
DRUGS Time
Date Regulation
INCORPORATED SIGNATURE Consumed SIGNATURE
Started
BLOOD TYPE

Followed-
10/25/21 1 D5LRS 1L x 20hrs 16-17 gtts/min 8:05 Started/RJA 4:05/RJA
up/RJA

Followed
10/25/21 2 D5LRS 1L x 20hrs 16-17 gtts/min 4:05 7:00/RJA Revised/RJA
up/RJA

10/25/21 2 D5LRS 1L x 20hrs 20 gtts/min 7:05 Started/RJA