Patient Care Instructions 5 Per Page
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2RM
Isolation
RM
Isolation
RM
Isolation
RM
Isolation
RM
Isolation
NAME
NAME
NAME
NAME
NAME
MD
MD
MD
MD
MD
DX/DATE
DX/DATE
DX/DATE
DX/DATE
DX/DATE
PMH
PMH
PMH
PMH
PMH
Allergies
Allergies
Allergies
Allergies
Allergies
IV
IV
IV
IV
IV
Activity
Activity
Activity
Activity
Activity
Neuro AAO x
Neuro AAO x
Neuro AAO x
Neuro AAO x
Neuro AAOX
RUE RLE LUE LLE
RUE RLE LUE LLE
RUE RLE LUE LLE
RUE RLE LUE LLE
RUE RLE LUE LLE
Speech C S A
Speech C S A
Speech C S A
Speech C S A
Speech C S A
Pupils
Pupils
Pupils
Pupils
Pupils
Cardio:
Cardio:
Cardio:
Cardio:
Cardio:
Tele:
Edema:
Tele:
Edema:
Tele:
Edema:
Tele:
Edema:
Tele:
Edema:
O
O
O
O
O
2
2
2
2
2
Lung Sounds
Lung Sounds
Lung Sounds
Lung Sounds
Lung Sounds
Cough
Cough
Cough
Cough
Cough
GI/Diet
GI/Diet
GI/Diet
GI/Diet
GI/Diet
BS
BS
BS
BS
BS
Last BM
/
Last BM
/
Last BM
/
Last BM
/
Last BM
/
GU URINE
GU URINE
GU URINE
GU URINE
GU URINE
VOO URINAL FOLEY CATH
VOO URINAL FOLEY CATH
VOO URINAL FOLEY CATH
VOO URINAL FOLEY CATH
VOO URINAL FOLEY CATH
SKIN/WOUND
SKIN/WOUND
SKIN/WOUND
SKIN/WOUND
SKIN/WOUND
DRAINS
Output
DRAINS
Output
Drains
Output
Drains
Output
Drains
Output
D/C
D/C
D/C
D/C
D/C
PAIN
PAIN
PAIN
PAIN
PAIN
MEDS
MEDS
MEDS
MEDS
MEDs
Consult PT OT RD WOCN
Consult PT OT RD WOCN
Consult PT OT RD WOCN
Consult PT OT RD WOCN
Consult PT OT RD WOCN
Report/Off unit
Report/Off unit
Report/Off unit
Report/Off unit
Report/Off unit
FSBS
HX
FSBS
HX
FSBS
HX
FSBS
HX
FSBS
HX
Tmp
HR
RR
BP
O
TMP
HR
RR
BP
O
TMP
HR
RR
BP
O
TMP
HR
RR
BP
O
TMP
HR
RR
BP
O
2
2
2
2
2
Notes
Notes
Notes
Notes
Notes
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