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  • ASSESS Done ASSESS Done ASSESS Done ASSESS Done ASSESS Done

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    Kim Bryant
    17 views2 pages
    This document appears to be a template for collecting patient information across 5 rooms. It includes fields for patient name, age, diagnosis, attending physician, consults, past medical history, screening for infectious diseases, vital signs, cardiac status, pulmonary exam, gastrointestinal exam, diet, genitourinary exam, skin exam, core measures, emergency contact, discharge plans, procedures, and documentation requirements. The template is used to standardize data collection for multiple patients.

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    Report Sheet

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    This document appears to be a template for collecting patient information across 5 rooms. It includes fields for patient name, age, diagnosis, attending physician, consults, past medical history, screening for infectious diseases, vital signs, cardiac status, pulmonary exam, gastrointestinal exam, diet, genitourinary exam, skin exam, core measures, emergency contact, discharge plans, procedures, and documentation requirements. The template is used to standardize data collection for multiple patients.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    17 views2 pages

    ASSESS Done ASSESS Done ASSESS Done ASSESS Done ASSESS Done

    Uploaded by

    Kim Bryant
    This document appears to be a template for collecting patient information across 5 rooms. It includes fields for patient name, age, diagnosis, attending physician, consults, past medical history, screening for infectious diseases, vital signs, cardiac status, pulmonary exam, gastrointestinal exam, diet, genitourinary exam, skin exam, core measures, emergency contact, discharge plans, procedures, and documentation requirements. The template is used to standardize data collection for multiple patients.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    Room# ______ Room# ______ Room# ______ Room# ______ Room# ______

    Name/Age
    Dx
    Attending

    Consults

    PMH
    Code
    □MRSA □VRE □ESBL □MRSA □VRE □ESBL □MRSA □VRE □ESBL □MRSA □VRE □ESBL □MRSA □VRE □ESBL
    □TB □CDIFF □MDRO □TB □CDIFF □MDRO □TB □CDIFF □MDRO □TB □CDIFF □MDRO □TB □CDIFF □MDRO
    SKIN ______ ______ ______ ______ ______
    □8/9 □ 10/11 □8/9 □ 10/11 □8/9 □ 10/11 □8/9 □ 10/11 □8/9 □ 10/11
    □13/14 □15/16 □13/14 □15/16 □13/14 □15/16 □13/14 □15/16 □13/14 □15/16
    MED TIMES □17/18 □17/18 □17/18 □17/18 □17/18
    Labs
    Radiology
    achs q6h achs q6h achs q6h achs q6h achs q6h
    CBG'S

    High Med
    Low = ____U ____U ____U = ____U ____U ____U = ____U ____U ____U = ____U ____U ____U = ____U ____U ____U

    A/O X ____ Confused A/O X ____ Confused A/O X ____ Confused A/O X ____ Confused A/O X ____ Confused
    Neuro Forgetful Nonverbal Forgetful Nonverbal Forgetful Nonverbal Forgetful Nonverbal Forgetful Nonverbal
    SR SB ST AFIB SR SB ST AFIB SR SB ST AFIB SR SB ST AFIB SR SB ST AFIB
    Cardiac _____ _____ _____ _____ _____
    IV SITE #1 #1 #1 #1 #1
    #2 #2 #2 #2 #2
    IVF/ Drips CTA Whz Rales CTA Whz Rales CTA Whz Rales CTA Whz Rales CTA Whz Rales
    Rhonchi RA Rhonchi RA Rhonchi RA Rhonchi RA Rhonchi RA
    Pulmo O2@____ Sats____ O2@____ Sats____ O2@____ Sats____ O2@____ Sats____ O2@____ Sats____
    GI BSx4 Hypo Hyper BSx4 Hypo Hyper BSx4 Hypo Hyper BSx4 Hypo Hyper BSx4 Hypo Hyper
    Reg Renal CLD Reg Renal CLD Reg Renal CLD Reg Renal CLD Reg Renal CLD
    Diet FLD other_______ FLD other_______ FLD other_______ FLD other_______ FLD other_______
    BRP Foley Ext. BRP Foley Ext. BRP Foley Ext. BRP Foley Ext. BRP Foley Ext.
    GU device Incont. device Incont. device Incont. device Incont. device Incont.
    Intact - Open - Wounds Intact - Open - Wounds Intact - Open - Wounds Intact - Open - Wounds Intact - Open - Wounds
    1ET cx 1SKIN 1ET cx 1SKIN 1ET cx 1SKIN 1ET cx 1SKIN 1ET cx 1SKIN
    ASSESS done ASSESS done ASSESS done ASSESS done ASSESS done
    SKIN

    CVA COPD CHF ______ CVA COPD CHF ______ CVA COPD CHF ______ CVA COPD CHF ______ CVA COPD CHF ______
    Core measure VTE ______ VTE ______ VTE ______ VTE ______ VTE ______
    Emergency
    Contact Home HHC SNF Home HHC SNF Home HHC SNF Home HHC SNF Home HHC SNF
    Rehab Other Rehab Other Rehab Other Rehab Other Rehab Other
    D/C plans ______________ ______________ ______________ ______________ ______________
    procedures

    Assess/Safety/Task/ Assess/Safety/Task/ Assess/Safety/Task/ Assess/Safety/Task/ Assess/Safety/Task/


    Documentation ED/IV/IPOC/Amb/I- ED/IV/IPOC/Amb/I- ED/IV/IPOC/Amb/I- ED/IV/IPOC/Amb/I- ED/IV/IPOC/Amb/I-
    aware/I&O aware/I&O aware/I&O aware/I&O aware/I&O

    other info

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