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ADMISSION ASSESSMENT AND HISTORY MEDICINE/SURGERY Pre–Admission – Date/Time Verification of patient ID band Admission – Date/Time  See Notes Reviewed and completed by:
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Document Date: 2013-06-05 15:47:32

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Company

Jaundice Oily Eczema Pruritus Cyanosis Lumps Swelling Limited / /

IndustryTerm

transportation / /

MedicalCondition

pain / Allergies / TB / last influenza / HIV / MS / Lesions Pale Diaphoretic Herpes zoster Tattoos Integ Abrasions Flushed Dehydrated Herpes / /

MedicalTreatment

immunization / Complementary therapies / Chiropractic / Occupational therapy / Counseling / catheter / SURGERY / blood transfusions / Insulin pump / Respiratory therapy / /

Movie

Next of Kin / /

MusicGroup

MEDICINE / Admission / HISTORY / /

Person

URI COPD / /

Position

Rt / Notes Language Spoken Translator / AM PM / Walker / /

Product

Medications See Medication / Physical layout Medication / Pre-op / /

Technology

X-ray / /

SocialTag