PERPETUAL HELP MEDICAL CENTER - BINAN

UPH - DR. JOSE G. TAMAYO MEDICAL UNIVERCITY FOUNDATION, INC

KARDEX
L4-NSD-011 Rev 01
SPECIAL ENDORSMENT: RECOPIED BY:
DATE DIET ACTIVITY CONTRAPTIONS

DATE SPECIAL NEEDS DATE PROCEDURE DATE REFERRALS

 DATE
DATE PARENTERAL FLUIDS DATE DIAGNOSTIC EXAM DATE RESULT
DONE IN
DATE CBG MONITORING DATE BLOOD TRANSFUSION

MEDICATIONS DATE PRN MEDICATIONS

DATE TREATMENT

DATE DAILY RECORD

AGE: GENDER: RELIGION: CASE STATUS: ADM.# HOSP.#

ATTENDING PHYSICIAN: ADM.DATE: DATE OF BIRTH:

CHIEF COMPLAINTS: HEIGHT: WEIGHT:

INITIAL DIAGNOSIS: SURGERY PERFORMED:

PATIENT NAME: CIVIL STATUS: RM.#

UPH-DR.JOSE G. TAMAYO MEDICAL UNIVERCITY FOUNDATION, INC.

National highway, Sto. Nino, City of Binan, Laguna
Tel. No: (632) 779-5310/ (6349) 544-5150