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  • Gender M F Marital Status: Rizal Medical Center

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    maKitten08
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    The document appears to be a template for patient records in a post-operative anesthesia care unit (PACU). However, most of the fields are blank as it is a template. It collects information such as the patient's name, date of birth, gender, chief complaint, pertinent medical history, procedures, anesthesia used, intraoperative findings, lab results and medications. Multiple pages of the same template are provided.

    Original Description:

    Original Title

    PACU CENSUS 2021

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    The document appears to be a template for patient records in a post-operative anesthesia care unit (PACU). However, most of the fields are blank as it is a template. It collects information such as the patient's name, date of birth, gender, chief complaint, pertinent medical history, procedures, anesthesia used, intraoperative findings, lab results and medications. Multiple pages of the same template are provided.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    21 views21 pages

    Gender M F Marital Status: Rizal Medical Center

    Uploaded by

    maKitten08
    The document appears to be a template for patient records in a post-operative anesthesia care unit (PACU). However, most of the fields are blank as it is a template. It collects information such as the patient's name, date of birth, gender, chief complaint, pertinent medical history, procedures, anesthesia used, intraoperative findings, lab results and medications. Multiple pages of the same template are provided.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 21

    DATE: RIZAL MEDICAL CENTER

    DEPARTMENT OF ANESTHESIOLOGY AND PERIOPERATIVE MEDICINE


    TIME: Click or tap here to enter text. POST OPERATIVE ANESTHESIA CARE UNIT (PACU)
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.
    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

    Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
    LAST NAME FIRST NAME MIDDLE NAME PATIENT NUMBER #
    DATE OF BIRTH (mm/dd/yyyy) GENDER ☐ M ☐ F MARITAL STATUS Choose an item.
    TIME Click or tap here CHIEF COMPLAINT: Click or tap here to enter text. LABORATORIES MEDICATIONS:
    IN: to enter text. PERTINENT HISTORY: Click or tap here to enter text. Click or tap here to enter text.
    TIME Click or tap here Click or tap here to enter text.
    OUT: to enter text.
    ASA Click or tap here
    to enter text.
    MAL Choose an item. PE FINDINGS: CHART NOTES:
    PROCEDURE DONE: Click or tap here to enter text. Click or tap here to enter text.
    Click or tap here to
    enter text.
    ANESTHESIA: INTRAOPERATIVE FINDINGS:
    Choose an item. Click or tap here to enter text.

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