Title Page
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Patient Name
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Patient Room
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Conducted on
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Prepared by
General Information
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Date of Birth
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Sex
Patient Report
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Diagnosis
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Does the patient has allergies?
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Please enter details
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Patient medical history
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Code status
Patient Monitoring - Vital Signs
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Click + to add patient monitoring details
Patient Check
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Time Check
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Blood Pressure
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Heart Rate
Temperature
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Oxygen Saturation
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Oxygen
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Respiratory Rate
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Pain
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Blood Sugars
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Are there dispensed medications?
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Time of Med Pass
Intake
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Breakfast
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Lunch
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Supper
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Other
Output
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Foley
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BM
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Emesis
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Drains
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Tubes
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Ostomy Bag
Labs and Needed Procedures
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Labs
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Needed Labs
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Future Procedures
Completion
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Click + to add Nurse On Duty
Nurse
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Full Name and Signature of Nurse Attendee