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Patient Allergies: Medication (Name/Classification/ Dose)

Patient Drug Allergies: Action and Adverse Effects Reason for Giving and Special Assessment

Diagnostics: Date of Procedure:

K Normal Value: 3.5 5.0 mEq/L Pt. Value: Reason Abnormal Na Normal Value: 135-148 mEq/L Pt. Value: Reason Abnormal BUN Normal Value: 8-25 mg/100 ml Pt. Value: Reason Abnormal Creatinine Normal Value: 0.6-1.5 mg/100ml Pt. Value: Reason Abnormal Creatinine Clearance Normal Value: Pt. Value: Reason Abnormal

Hct Male Female Normal Value 37-49% 36-46% Pt. Value: Reason Abnormal Low - blood loss, anemia, over hydration Hgb Male Female Normal Value 13.8-18 g/dl 12-16 g/dl Pt. Value: Reason Abnormal Low - blood loss, anemia WBC Normal Value: 3.8 11.0 Pt. Value: Reason Abnormal 10^3/mm3

PLT Normal Value: 150,000 350,000 Pt. Value: Reason Abnormal Low thrombocytopenic purpura, viral infection PT Normal Value: 10-14 seconds Pt. Value:

Reason Abnormal Glucose Normal Value: 65-99 mEq/L Pt. Value: Reason Abnormal Ca Normal Value 8.9 10.4 mg/dl Pt. Value: Reason Abnormal Albumin Normal Value: 3.5 5.0 mg/dl Pt. Value: Reason Abnormal Troponin Normal Value Pt. Value: Reason Abnormal UA Normal Value: Pt. Value: Reason Abnormal EKG Interpretation: INR Normal Value: 1 to 2 Pt. Value: Reason Abnormal PTT Normal Value: 30 45 seconds Pt. Value: Reason Abnormal low- not clotting, liver damage AST Normal Value: w/ 9-25 U/L Pt. Value: Reason Abnormal- High- liver disease, liver injury ALT Normal Value w/ 7-30 U/L Pt. Value: Reason Abnormal High not clinically significant DX: CXR Impression: N/A ABGs pH Range PaO2 Range HCO3 Range PaCO2 Range

Normal Normal Normal Normal

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