Patient Care Report 4
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1Rm #_____ Name______________ Age:_____
V/S q____h Neuro q_____h FSBS___________
MD:________________________
Temp HR RR O2 Pain FSBS
HX
Admitted:________ DX:_____________________
0800
PMH:____________________________________
1200
1600
Allergies:_________________________________
F/U call MD meds
chart
IV
#_____ L / R _______W/_________
#_____ L / R _______W/_________
Activity:
NEURO: A & O x ____ Follow Commands Y N
Labs/TX:
Speech: C S A MAE Y N
RUE RLE ULE LLE
Pupils
Notes:
R/l____mm B /S/ NR L/l____mm B /S/ NR
Cardio
Tele
Skin/Wounds
Resp/O2
Diet
Last BM
GU Foley VOO
Rm #_____ Name______________ Age:_____
V/S q____h Neuro q_____h FSBS_________
MD:________________________
Temp HR RR O2 Pain FSBS
Admitted:________ DX:_____________________
HX
PMH:____________________________________
0800
Allergies:_________________________________
1200
1600
IV
#_____ L / R _______W/_________
F/U call MD meds chart
#_____ L / R _______W/_________
Activity:
NEURO: A & O x ____ Follow Commands Y N
LABS/TX:
Notes:
Speech: C S A MAE Y N
RUE RLE ULE LLE
Pupils
R/l____mm B /S/ NR L/l____mm B /S/ NR
Cardio
Tele
Skin/Wounds
Resp/O2
Diet
Last BM
GU Foley VOO
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