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Rehab Report checklist

Locate your client’s chart and kardex and find the following:

Name (initials only): _________________room #: ________ allergies: _______________________

Age: ________Gender: ______Admitting diagnosis: __________________________________________

Language spoken: ______________________________ sensory deficits (vision or hearing?): _________


Past Medical History: ___________________________________________________________________

_____________________________________________________________________________________

Past Surgical History: __________________________________________________________________

_____________________________________________________________________________________

Priority Assessment: ____________________________ Therapy times: _________________________

Diet: _______________________ Mobility/ Transfer orders: ___________________________________

ADLS: Hygiene/ Toileting: _________________________ Dressing: _________________________

Safety precautions/ Isolation: ____________________________________________________________

Wound care orders: ____________________________________________________________________

Discharge date and destination:

In Orders:

Read and review each order

Note frequency of vital signs or other monitoring (blood sugar, weight, etc)

MAR :

Check to see what medications are scheduled for your shift and times due:

Note last time prn meds given:

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