Escolar Documentos
Profissional Documentos
Cultura Documentos
Name/Age/Gender
Allergies:
Physician:
Admit Date:
Code:
Diagnosis/Proce
dure
Diet:
Activity:
Accu
0800
1200
1600
2000
I&O
0800
1200
1600
2000
Heart
Rhythm:____________O2___L/NC
Vital signs: B/P HR Resp Temp
%Sat
0800
1200
1600
2000
IVsite _____PICC Central __ports
Art line
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
PCA
______base____dose____bolus_____
Ng Foley CT JP Penrose
Trach
I&O
I&O
I&O
0800____ 0800____ 0800____
1200____ 1200____ 1200____
1600____ 1600____ 1600____
RM#
Name/Age/Gender
Allergies:
Physician:
Admit Date:
Code:
Diagnosis/Proce
dure
RM#
Name/Age/Gender
Allergies:
Physician:
Admit Date:
Code:
Diagnosis/Proce
dure
RM#
Name/Age/Gender
Allergies:
Physician:
Admit Date:
Code:
Diagnosis/Proce
dure
Diet:
Diet:
Diet:
Accu
I&O
0800
0800
Activity:
1200
1200
1600
1600
2000
2000
Heart Rhythm:
__________O2___L/NC
Vital signs: B/P HR Resp Temp
%Sat
0800
1200
1600
2000
IVsite ____PICC Central __ports
Art line
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
PCA
______base____dose____bolus____
Ng Foley CT JP Penrose
Trach
I&O
I&O
I&O
0800____ 0800____ 0800____
1200____ 1200____ 1200____
1600____ 1600____ 1600____
Accu
I&O
0800
0800
Activity:
1200
1200
1600
1600
2000
2000
Heart Rhythm:
__________O2___L/NC
Vital signs: B/P HR Resp Temp
%Sat
0800
1200
1600
2000
IVsite ____PICC Central __ports
Art line
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
PCA
______base____dose____bolus____
Ng Foley CT JP Penrose
Trach
I&O
I&O
I&O
0800____ 0800____ 0800____
1200____ 1200____ 1200____
1600____ 1600____ 1600____
Activity:
Accu
0800
1200
1600
2000
I&O
0800
1200
1600
2000
Heart
Rhythm:___________O2____L/NC
Vital signs: B/P HR Resp Temp
%Sat
0800
1200
1600
2000
IVsite ____PICC Central __ports
Art line
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
Solution______w_____@______mls
PCA
______base____dose____bolus____
Ng Foley CT JP Penrose
Trach
I&O
I&O
I&O
0800____ 0800____ 0800____
1200____ 1200____ 1200____
1600____ 1600____ 1600____
Rm#
List meds
Rm#
List meds
Rm#
List meds
Rm#
List meds
Name
Ca+
Mg+ Phos
PTT
Ck
CKMB
Trop
Other
To DO ---Comments
PT INR
Name
Ca+
Mg+ Phos
PTT
Ck
CKMB
Trop
Other
To DO ---Comments
PT INR
Name
Ca+
Mg+ Phos
PTT
Ck
CKMB
Trop
Other
To DO ---Comments
PT INR
Name
Ca+
Mg+ Phos
PTT
Ck
CKMB
Trop
Other
To DO ---Comments
PT INR