Consultant-In-Charge: __________________________ Private/RMC:__________________ Date:___________________

Resident-In-Charge: ____________________________

General Data Progress Notes Meds on Board

Name: ( ) Fever;
( ) Headache; ( ) Dizziness
( ) Seizure; ( ) Nausea
Age/Sex/Stat: ( ) Vomiting: ___ x;
Address: ( ) Cough; ( ) DOB
Religion: ( ) Constipation;
Occupation: ( ) Diarrhea; ___x
Room: ( ) Abd. Pain:
Case #: Location:
Date Adm: Quality:
Day of Hosp.: Lab Results
Diagnosis:

BP :________ T: ___________
PR: ________ RR: _________
O2SAT:_____%

P.E.

Remarks
Consultant-In-Charge: __________________________ Private/RMC:__________________ Date:___________________
Resident-In-Charge: ____________________________

General Data Brief Hx & P.E. ADMITTING ORDER

Name: CC: Diet: ( ) NPO; ( ) DAT; ( ) ↓salt, fat; ( ) DM diet; ( ) ↓purine; ( ) ↓protein;
( ) soft; ( ) ↓ residue; ( ) Hypoallergenic; ( ) Others:
IVF:
Age/Sex/Stat: Dx: ( ) CBC; ( ) Na; ( ) K; ( ) Ca; ( ) Mg; ( ) Crea; ( ) FBS; ( ) LP; ( ) BUA; ( ) RBS
Address: ( ) PT; ( ) aPTT; ( ) CXR ____ view; ( ) 12L ECG; ( ) UTZ:
Religion: ( ) UA; ( ) FA ; ( ) CKMB; ( ) Trop I
Occupation: Meds:
Room:
Case #:

BP :
PR:
RR:
O2SAT:_____%
T: Lab Results
Diagnosis:

P.E.

Remarks