Pt Info

Room

Isolation Code Fall Level Precautions
Allergies

MD
Chief Complaint 1
st
Dx 2
nd
Dx



History / Surgeries





Core Measures

Prophylaxis: GI/DVT


Vaccines: PNA/Flu
Neurological Cardiovascular



Respiratory



GI


Diet
GU


Foley Date
Ortho/Mobility/Activity

Endocrine/Accuchek IVT/Drips



Skin/Wound Care PU Risk? Y / N

Meds



PRN
Labs & Diagnostics







ICU Protocols To Collect
Notes / To Do / Family / Issues













Personal Equipment



Transfer/Discharge Plans

Documentation
I&O

V/S

H2T
POC/Edu