ABCDEFGHIJKLMNOPQRST
1
ROOM:NAME:AGE:ATTENDING:PRECAUTIONS:ALLERGIES:
2
FALL RISK:
3
ADM DX:
4
PMH:DISCHARGE:
5
SURGERY:DIET:
6
ACTIVITY:
7
ASSESSMENTLDAINTAKEOUTPUTBGBLDHS
8
PREVIOUS TODAYTIME
9
NEUROCOVERAGE
10
11
TELEDSGLOCATIONASSESSMENTDSG CHANGE?
12
0700/1900
13
CARDIAC1100/2300
14
1500/0300
15
RYTHM
16
17
RESPTRANSPORT?
18
TROPONIN
19
20
DATE/TIMELABS
21
GI
22
23
24
MED TIMESORDERS
25
GU
26
27
28
29
SKIN
30
31
32
33
PULSES
34
35
36
37
PREVIOUS SHIFT:
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100