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  • Ria Laelasari (El)

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    momon
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    Janice Smith, a 17-year-old female student, was admitted to the emergency unit of the hospital on October 13, 2022 at 2:56 pm via stretcher with no orientation to her environment. She has been experiencing pharyngitis for 4 days and is allergic to shrimp and penicillin. Her vital signs and medical history were recorded upon admission.

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    RIA LAELASARI (EL)

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    RIA LAELASARI (EL)

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    Janice Smith, a 17-year-old female student, was admitted to the emergency unit of the hospital on October 13, 2022 at 2:56 pm via stretcher with no orientation to her environment. She has been experiencing pharyngitis for 4 days and is allergic to shrimp and penicillin. Her vital signs and medical history were recorded upon admission.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    2 views1 page

    Ria Laelasari (El)

    Uploaded by

    momon
    Janice Smith, a 17-year-old female student, was admitted to the emergency unit of the hospital on October 13, 2022 at 2:56 pm via stretcher with no orientation to her environment. She has been experiencing pharyngitis for 4 days and is allergic to shrimp and penicillin. Her vital signs and medical history were recorded upon admission.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    CANADA'S HOSPITAL CENTER

    ADMISSION FORM

    Hospital Reg. No Unit Adm. Date Adm. Time


    01.32.33.45.89 Emergency Unit 10/13/2022 14:56
    Complete Name First Name Family Name ID No.
    Janice Smith Janice Smith 32110877635672800
    Age (DOB/POB) Sex Religion Marital Status Occupation
    17 ( )M ( V )F Islam ( )M ( V )S ( )W ( )Wr Student
    Transport Mode ( ) WC ( ) Walking ( V ) Strechers ( ) Other
    Oriented to Environment ( ) Yes ( V ) No
    Permanent Address

    Cadburry Street No.01 West Rock, Canada

    Zip Code 564311 Phone No


    Name & Address of Next Kin
    Johnson Smith
    Cadburry Street No.01 West Rock, Canada

    Zip Code 564311 Phone No. 0765-84995231


    Relationship Father
    Allergic Yes ( V ) Food : Shrimp ( V )Meds/Other : Penicillin
    Admitting Vital Sign Temp Pulse Respiration B/P Weight/Height
    10/14/2022 37.5 89 17 110/70 45 Kg/165 cm

    HEALTH HISTORY
    Current Medication Last Dose Cardiac Medication Last Dose
    Amoxil 3 X 500 mgs No
    FG Throches 2 X 1 Tab
    Panadol 3 X 500 mgs

    PAST MEDICAL & SURGICAL HISTORY Complete By Date


    Pharyngitis for 4 days Nurse Riri 10/13/2022

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