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Name:
Rm# Age:
Abnormal and pertinent normal assessment findings: Neuro: Admit date: Resp: CV: Rhythm:
Name:
Doctor/Consults:
Reason for Admit Admit date:
Abnormal and pertinent normal assessment findings: Neuro: Resp: CV: Rhythm:
Activity:
Code Status:
Isolation:
Resp Tx: O2
Monitor:
Resp Tx: O2
Monitor:
I/O:
I/O:
Meds:
Shift Goals
Shift Goals