ADVENTIST MEDICAL CENTER COLLEGE Control No.

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ENDORSEMENT KARDEX

DATE DIAGNOSTIC FF R C DATE DIAGNOSTIC FF R C DATE SERIAL MONITORING

ORDERED PROCEDURE ORDERED PROCEDURE ORDERED

Chief Complaints: _____________________________________________

Admitting Diagnosis: ___________________________________________

DATE ENDORSEMENT PRESENT STATUS SPECIAL ENDORSEMENT/PRECAUTION

Attending Physician: ________________________ Date of Discharge _______________________

Referral/Co-management ______________________ Discharge Instruction Given YES / NO / NA

Dressing Taught/Changed YES / NO / NA
Others ______________________________ Appointment Given YES / NO / NA
Informed Significant Others YES / NO / NA

Discharged by: _____________________________

NAME: _______________________________ AGE: _________ SEX: M / F Room No. : ____________

ENDORSEMENT KARDEX