ADMISSION DATABASE Name: Juan Perez DOB: 3/22 (age 29) Physician: Deborah Kuhls, MD repulse it on # DATE: period: TRIAGE STATUS (ER ONLY): 5 ? 7/1 ? 0730 ? Red ? Yellow ? Green ? White initial alert Signs TEMP: RESP: SAO 2 : 39 ? 22 HT (in): WT (lb): B/P: PULSE: 5 ? 10 ? ? 225 ? cxv/65 ? 90 go TETANUS rifle ATE LAST DRANK unknown region unknown ? unknown oral sex burster/HX OF PRESENT ILLNESS unresponsive ALLERGIES: Meds, Food, IVP Dye, Seafood: eccentric person of Reaction unknown PREVIOUS HOSPITALIZATIONS/SURGERIES unknown first psyche TO CONTACT: Name: N/A Home #: move rough #: ORIENTATION TO UNIT: ? bellyache light ? Television/telephone ? Bathroom ? Visiting ? Smoking ? Meals ? Patient rights/responsibilities personal ARTICLES: (Check if retained/describe) ? Contacts ? R ? L ? Dentures ? Upper ? Lower ? Jewelry: necklace ? opposite: ? VALUABLES ENVELOPE: ? ? Valuables instructions INFORMATION OBTAINED FROM: ? Patient ? antecede record ? Family ? Responsible party Signature Home medicaments (including OTC) autographs: A ? displace homeB ? Sent to pharmacyC ? Not brought in medicinal drug Dose frequence condemnation of Last Dose mandate Patient Understanding of Drug unknown Do you take all medications as prescribed? ? Yes ? No If no, why?
PATIENT/FAMILY HISTORY ? Cold in past two weeks ? hay fever ? Emphysema/lung problems ? TB trouble oneself/positive TB strip down test ? Cancer ? Stroke/past paralysis ? kindle attack ? Angina/chest pain ? nervus problems RISK SCREENING Have you had a blood transfusion? ? Yes ? No Do you smoke? ? Yes ? No If yes, how mevery pack(s)? Does anyone in your abode smoke? ? Yes ? No Do you inebriation alcohol? ? Yes ? No If yes, how lots? How oftentimes? When was your die drink? ? ______/______/______ Do you take any unskilled drugs? ? Yes ? No If yes, type:______ Route: Frequency:______ Date last use:______/______/______ ? High blood pressure ?...If you requisite to get a near essay, order it on our website:
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