ACEMCPAL-04-NSD-045-00

Address: South National Highway, San Pedro, Puerto Princesa City Tel No.: (048) 717 0019

Classification: Hospital No.:

KARDEX
Membership: Date of Birth:
Room/Bed No.: Last Name: First Name: Middle Name:

Address: Chief Complaint: Age: Gender: M/F

Height (cm): Weight (kg):
Allergies: Diet:

Admission Date/Time:

Trans-in Date/Time: Status/Date Sign:

Attending Physicians: DNR Level of Care: I II III IV
DNI
Admitting Diagnosis: Date Started Contraption Date/Time/DC
  02 at __ lpm via ___  
  IV / Heplock  
  NGT / PEG/ GT  
Surgical Procedure/Date:   CTT  
  IFC / CC  
  Others  
Date / Time Treatment Remarks

This document is a property of Allied Care Experts (ACE) Medical Center Palawan and the contents are treated confidential therefore, unauthorized
reproduction is strictly prohibited unless otherwise permitted by ACEMC -Palawan Management.
NSD21-048