EASTERN VISAYAS MEDICAL CENTER

KARDEX FORM

Name of Patient :
(Surname) (First Name) (Middle Name)

Sex : Female Male Date of Birth : Age :

Address : Contact No. :

Ward : Room/Bed No. : Hospital No. :
Date Admitted : Diet :
Chief Complaint :

Attending Physician :

LAB. DIAGNOSTIC
DATE IVF MEDICATION SP. ENDORSEMENT NURSE ON DUTY
EXAMS
08/27/21 PLR 1l @30 Piperacillin-Tazobactam Repeat electrolyte panel Low Residue Diet + Victor Noroña, RN
gtts/min 4.5 grams IV q 8 hrs Ensure Feeding
HBA1C
Metronidazole 500 mg IV Transfer 2 units of
q 8 hrs
Discontinue human FBS PRBC
albumin