CARRYING OUT OF DOCTORS ORDER

AND FDAR DOCUMENTATION

(COTABATO REGIONAL AND MEDICAL CENTER)

INSTRUCTIONS:
1. Review the video lecture on carrying-out the doctor’s order and FDAR format of
documentation.
2. Carry-out the doctor’s order by filling-out the following forms:
a. Doctor’s Order
b. Kardex
c. IV Flow Sheet
d. Vital Signs record
e. IVF tag
3. Based on the scenario given and doctors order make nurses or progress notes in FDAR
format using the form below.

SCENARIO: At around 6: 45 AM , a 25 y.o., G1P0, pregnant woman went to the delivery room due
to lumbosacral pain, excessive sweating, and facial grimacing . She verbalizes “masakit masyado ang
tiyan ko'' while holding her abdomen. Her BP is 140 beats/min, respiratory rate of 25 breaths/ min.
Internal examination revealed 5 cms. dilated, thus she was admitted with the following orders.. (see
attached DOCTOR'S ORDER SHEET).
 Republic of the Philippines
Department of Health
COTABATO REGIONAL AND MEDICAL CENTER

SURNAME AGE

GIVEN NAME SEX

[ ]M[ ]F

DOCTORS ORDER/NURSES COMPLIANCE SHEET

(Authenticated all order)

C- Carried A- administered R- Request made

E- Endorsed D- Discontinue

Date C A R E D Time

Time ORDER Posted

Signature
3/28/2020 Chief Complaint (CC)- lumbosacral pain LOP

7:00am -Please admit under the service of DR. Lu LOP

-consent to care LOP

-start venoclysis with D5LR iL; incorporate

10 units of oxytocin to run at 30 drops / min. LOP

-Diagnostics/ laboratories

- CBC, BT and platelet count LOP

- urinalysis LOP

-hooked to Electronic Fetal Monitor (EFM) LOP

-monitor Fetal Heart Tone (FHT) every 30 LOP

 minutes and record please. LOP

-Vital signs (VS) every 4 hours LOP

-Nothing per orem (NPO) when in active labor LOP

-Refer Accordingly LOP

DR. Marilyn Lu

Republic of the Philippines

Department of Health
COTABATO REGIONAL AND MEDICAL CENTER

Name of Patient: _____________________________Hospital

Patient X Record No. ___________
1234

INTRAVENOUS FLUID FLOW SHEET

TYPE OF IVF DATE AND TIME SIGNATURE DATE AND SIGNATURE REMARKS
HOOKED TIME
No. CONSUMED

1 D5LR iL 3-28-20/

7:00 am
__________________
Patient X _____________
X __________
X Hospital No. _____________
1234
Surname First Name M.I. Room No. _______________
1

VITAL SIGNS RECORD

DATE SHIFT BLOOD CARDIAC/ RESPIRATOR TEMPERATURE O2 PVC Weight Abdominal

PRESSURE PULSE Y RATE Sat. Girth
TIME RATE

3-28- 7-3 140/80 Not 25bpm Not given Not Not Not Not
20 stated give give given given
pm Beats/ n n
mins
Not stated Not stated
Not stated
D5LR 1L
10 units of oxytocin
30gtts/min
03-28-29/7AM