REPUBLIC OF THE PHILIPPINES

VETERANS MEMORIAL MEDICAL CENTER

PHIC ACCREDITED HEALTH CARE PROVIDER

MEDICAL RECORDS UNIT

CR2

PATIENT’S NAME AGE SEX RACE CLAIM NO. SOCIAL SECURITY NO. NAME OF HOSPITAL

VMMC

DIAGNOSES (List and number in order of clinical importance all established diagnoses for which treatment was given. ICDA CODE
Place the letter “X” before one diagnosis responsible for the major port if the patient’s stay. For Discharge to Nursing
Care, place the “N” before diagnosis responsible for Nursing Care placement.

Major Diagnoses Noted But Not Treated

OPERATIONS PERFORMED AT THIS HOSPITAL DURING CURRENT ADMISSION Date

SUMMARY (Brief statement should include, if applicable, history, pertinent physical findings, course in the hospital, treatment give,
condition at discharge, date patient is capable of returning to full employment, period of convalescence, if required, recommendations for
follow-up treatment, medications furnished at discharge, competency opinion, and name of Nursing Home, if known

History of Present
Illness:

Review of Systems:

Past Medical
History:

Family Medical
History:

Personal/ Social
History:

Admission Date Discharge Date Type of Discharge Inpatient Days ABO Days Ward No. Signature of Physician

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 REPUBLIC OF THE PHILIPPINES
VETERANS MEMORIAL MEDICAL CENTER
PHIC ACCREDITED HEALTH CARE PROVIDER

Physical Examination
On Admission:

Assessment:

Course In The Ward:

PREPARED BY: CONCURRED WITH:

(Resident) Service Consultant

VMMC-MR_MAS-MRU FORM CR-2

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 REPUBLIC OF THE PHILIPPINES
VETERANS MEMORIAL MEDICAL CENTER
PHIC ACCREDITED HEALTH CARE PROVIDER

REVISED JULY 2019

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