Pneumonia Admission Orders (All Forms)
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4Name:______________________________
DOB:______________________________
Generic equivalents are utilized unless checked.
l
CORE MEASURE REQUIREMENTS
Physician Name(s)
Admit to Dr.______________________________
Inpatient
Status
Observation
Code Status
Code Status:________________________________________________________
_________________________________________________________________
Location
ICU
Telemetry
Medical
Other
Old chart to floor with patient.
Diagnosis
Community Acquired Pneumonia
( CAP )
Healthcare Associated Pneumonia ( HAP )
Condition
Good
Fair
Serious
Critical
Nursing Interventions
Vital Signs
Per unit Protocol
Other:_______________________
Activity
Bed Rest
with bedside commode
with bathroom privileges
Out of bed with assistance
Ambulation
Fall Prevention
Monitor
Pulse oximetry per unit routine and record
Interventions
Strict Recording of Intake and Output record
Daily weights (chart results)
Aspiration Precautions
Transcribed
Noted / Acknowledged
Signature
Date / Time
Signature
Date / Time
Telephone Order(TOR)
PHYSICIAN INITIALS
DATE / TIME
Originated 2010
rev Pneumonia Admission Orders Pg 1 of 4 public
Revised 5/12/11
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Parent category: Medical