Integrity • Professionalism • Commitment • Competence • Openness • Teamwork •

Patriotism
Max Y. Suniel St, Cagayan de Oro, 9000 Misamis Oriental
Email: info.coc@phinmaed.com +63 (088) 858-3880 / +63 917-376-5105

Name: _______________________________________________________ RLE Group/Section: _________ Hospital Area: _______________________

Clinical Instructor: _____________________________________________

KARDEX
TOTAL OF 50 POINTS

NAME OF PATIENT: ______________ SEX: ________ AGE: ___________ RELIGION: ________________ ALLERGIES: _____________________________

ADDRESS: ______________________________________________________________________________________________________________________________________________

CHIEF COMPLAINTS: _____________________________________________ ADMITTING DIAGNOSIS: _______________________________________________________________

ATTENDING PHYSICIAN: ___________________________________________________ CO-MANAGEMENT: ____________________________________________________________

Date and Time Special Notation/Procedure Laboratory/Dx. Procedure Medication IV Fluid Diet

PREPARED BY: __________________________________________________ NOTED BY: ______________________________________________

 Integrity • Professionalism • Commitment • Competence • Openness • Teamwork •
Patriotism
Max Y. Suniel St, Cagayan de Oro, 9000 Misamis Oriental
Email: info.coc@phinmaed.com +63 (088) 858-3880 / +63 917-376-5105

VITAL SIGNS

Patient Name: _______________________________

Date Time Blood Pressure Body Temperature Pulse Rate Respiratory Rate Oxygen Saturation
Level

Patient Name: _______________________________

Date Time Blood Pressure Body Temperature Pulse Rate Respiratory Rate Oxygen Saturation
Level
 Integrity • Professionalism • Commitment • Competence • Openness • Teamwork •
Patriotism
Max Y. Suniel St, Cagayan de Oro, 9000 Misamis Oriental
Email: info.coc@phinmaed.com +63 (088) 858-3880 / +63 917-376-5105

INTAKE AND OUTPUT

Patient Name: _______________________________

Date Time Oral Fluid Intake IV Fluid Others Total

Patient Name: _______________________________

Date Time Oral Fluid Intake IV Fluid Others Total

 Integrity • Professionalism • Commitment • Competence • Openness • Teamwork •
Patriotism
Max Y. Suniel St, Cagayan de Oro, 9000 Misamis Oriental
Email: info.coc@phinmaed.com +63 (088) 858-3880 / +63 917-376-5105

MEDICATION

Patient Name: _______________________________

Date Time Generic Name Brand Name Classification Indication Dosage Frequency Route

Patient Name: _______________________________

Date Time Generic Name Brand Name Classification Indication Dosage Frequency Route