1. Dx PMH
Neuro AOX 3 2 1 Confused Forgetful Cards SR ST SB AF FL EF_____ Venodynes
Resp _____LPM NC RA GI Incont Guiaic
GU Foley Voiding Incont Skin/Wound
Routine VS q4° Daily Wgt Strict I/O Labs BNP
Ca
T _______ BP _______
CK
Mag
HR _______ O2 ________
R _______ LS ________ PT/INR_______ PTT_______ Pho Trop
Meds Cath/EP Lab IV SL gtts
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Fent ________
Versed ______
FS
8______ 12 ______ 17 ______ 18 ______ 22 ______ Cont _______
IVF _________
Plans Call MD
HR <_____ >_____
SBP<_____ >_____
DBP> ____T>_____
RR <_____ >_____
O2 <____ PTT >____
RΔ Fall
Activity Precaution Diet
ad lib BR x _____° BRP AMB Fall Bleed ASP
OOB to Chair c Assist x _____ Cont Air Drop NPO HH 2gNA ______ADA Renal Regular
Name & Age Code Allergy NKDA MD N
R1 CC
Full DNR/I I/O
LC# DX Rm