NAME : ANA LISTIYANA

NIM : P1337424120061
TAKING A PATIENT HISTORY
Watch the Video and Take the Patient’s History

ADMISSION FORM
Title : Mr First name : Ron Surname : Jones

DOB : December 15 th 1955

Reason for admission :

Mr. Ron said he was on leave this week because he coughed and had yellow phlegm that sometimes looked
green and didn't have a fever.

Smoking : Yes Packs per day : 2

Allergies : None

VITAL SIGNS
Patient name : Ron Jones Date of birth : December 15 th 1955

BP P RR T Wt O2 Sats Signature
180/84 88 16 37c - - Nurse. Sue