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    Form For Physical Assessment

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    nicuacemctug2023
    The document is a newborn admission physical assessment form from a neonatal intensive care unit. It contains fields to record information about the newborn such as weight, measurements, and assessments of various body systems. The form is used to document the physical exam and determine an impression and care plan for the newborn.

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    Form For Physical Assessment

    Uploaded by

    nicuacemctug2023
    4 views1 page
    The document is a newborn admission physical assessment form from a neonatal intensive care unit. It contains fields to record information about the newborn such as weight, measurements, and assessments of various body systems. The form is used to document the physical exam and determine an impression and care plan for the newborn.

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    Form for Physical Assessment

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    The document is a newborn admission physical assessment form from a neonatal intensive care unit. It contains fields to record information about the newborn such as weight, measurements, and assessments of various body systems. The form is used to document the physical exam and determine an impression and care plan for the newborn.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    4 views1 page

    Form For Physical Assessment

    Uploaded by

    nicuacemctug2023
    The document is a newborn admission physical assessment form from a neonatal intensive care unit. It contains fields to record information about the newborn such as weight, measurements, and assessments of various body systems. The form is used to document the physical exam and determine an impression and care plan for the newborn.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Document No.

    NEONATAL INTENSIVE
    CARE UNIT ACEMCTUG-NSD-NICU-04-001-00

    Address: PALLUA ROAD, BRGY. PALLUA NORTE, TUGUEGARAO CITY Tel No.: (078) 825 0527 Page 1 of 1

    Newborn Admission Physical Assessment Form


    Date of Admission: Time: Date of Assessment: Time:

    Mother’s Name:

    Birth Weight: Birth Length: Head Circumference: Chest Circumference: Abdominal Circumference:
    grams cm cm cm cm
    Color Turgor Rash Desquamation
    SKIN

    HEAD Molding Scalp Fontanels Suture

    FACE

    EYES Conjuctiva Sclera Pupils Discharge

    EARS NOSE

    MOUTH Up Tongue Palate Fistula

    NECK Sternocleidomastoid

    Shape Respiration
    CHEST
    Clavicles Breast Heart Lungs

    ABDOMEN Spleen

    KIDNEYS Liver

    UMBILICAL
    CORD
    INGUINAL Diastasis recti
    HERNIA
    GENITALIA Male Female

    EXTREMITIES Arms Legs

    SPINE
    IMPRESSION

    PLAN: ( ) INTENSIVE CARE ( ) OBSERVATIONAL CARE ( ) ROUTINE CARE

    ACCOMPLISHED BY:

    ____________________________________________
    Attending Physician
    Signature over Printed Name

    NAME: AGE: PIN:


    DATE OF BIRTH: SEX: ROOM/BED #:
    ATTENDING PHYSICIAN:

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