ADMISSION CHECKLIST

PROCEDURE STEPS YES NO Remarks

Admission Details: PDS, Consent, Patient’s ID Service □
Private □
Temporary Service: □
Charging of Admitting Kit at BIzbox
Admitting Orders by
MROD/PROD/OBROD/SROD are complete?
Inform main service of patient’s admission
Inform other department of patient’s
admission ( Referrals)
Inform dietary of patient’s diet
History
Maintenance Medications:
Allergy history:

Covid 19 Positive Mild □

When: Moderate □
Where: Severe □
Brand:

Vaccination History: COVID 19 1st dose: □

2nd dose: □
Health Declaration Form
( if accompanied by relative)
Relative’s Name:
Age/ Gender
Date signed:
Covid Antigen Negative Result:
RT-PCR done: When:
Where:

Initial assessment Alert □

Level of Consciousness Lethargic □
GCS: Obtunded □
Stuporous □
Comatose □
Contraptions IVF □ HL □ IVF □ SD□
O2 support □ NC □ FM □ NRBM □
VM □ HFNC □
NGT □
IFC-UB □
Cardiac Monitor □
JP/Penrose drain □
Safety Low Risk □
Moderate Risk □
High Risk □
Initial Vital Signs T: PR: RR: BP: 02 sat: