DX

CODE STATUS

ISOLATION

PRECAUTIONS

MD

ALLERGIES

NEURO

WNL LABS

heparin drip

3% nacl drip

sedated paralyzed icp drains NIHSS

CARDIO

pacer / aicd ivc stents prn >

WNL CULTURES

SERIAL LABS
WNL
VENT

PULMO

ELECTROLYTE PROTOCOL
K
Mg
Ca

ett trach weaning chest tubes

GI

Phos

WNL IMAGING
NPO
TF

BS:
LBM:
TFR:
ng og peg colostomy drains SLP
ENDO

WNL IV ACCESS

Accuchek Q
insulin drip glucommander lantus / 70/30
PAST MEDICAL HISTORY

RENAL

DRIPS:

WNL

DIALYSIS
FAMILY / POA / ADVANCE DIRECTIVES YES

d/c foley dsg change:

ORTHO / MOBILITY

Device:

limb alert

protonix

PT/OT lovenox heparin

SKIN / LDAs

scds

other:

PRN MEDS

TEMP:

UO:

tpa

WNL PROPHYLAXIS
pepcid

NOTES

PIV PICC CVC HD

TEMP:

UO:

UO:

TEMP:

UO:

UO:

UO: