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RM # Name: Age: Admit: MD: Code:

DX: PMH: ISOLATION: Allergies:

IV Site: Labs Critical to MD/charted AM Labs


PT/INR
NA/K+
Dressing change: H/H
Orders to flush central/hep loc line/PICC Mg/Phos
NEURO: AAO x Speech: C S A Cardio: Tele: Edema O2 RA NC Humidification
PUPILS: R___ mm E R B Orders to travel w/o Lung Sounds Cough
L ___mm E R B Pulses: Radial Pedal
Facial Droop: Coumadin/Fragmin/Heparin Continuous Pulse OX I/S/Acapella
Tongue: Midline Drift SWALLOW TEST SCDs Hold BP Meds- RT: HHN TRACH
GI Diet: NPO GU URINE Intake- Skin/Wound PPD
NPO w/Meds FOLEY Output-
Bladder Scan
Fluid Restrictions
U/A C/S
Last BM: / PEG 24/HR Strict I/O s

Stool check DIALYSIS ORDERS/Consent


Checklist & MAR + B&T Dressing WOCN consult VAC/JP
M/S RU RL LU LL BKA ACITVITY Consults:
PT
Brace Cane Walker Wheelchair

V/S 0800 1200 1600 HX



T

HR

RR
B/P
O2
FSBS
PAIN

INSULIN Sliding Prandial

Off unit MEDS

Admission D/C
Legarcy Chart IV
Med Hx Vac
Allergy
MD orders

Test
Procedures

PPassport- Consent- MRI SCREEN SHEET


Pre-OP Proc McK Chart, Consent, Transfer Meds, MAR, V/S, On Call AB, H & P

BloodOrders for Type&Cross/ #unitsTransfus, Consent, Order for Pre-Med, Pearls, Chart input, F/U H&H

Chart: CP: EDU: Charge: Tech: PM Report:

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