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  • Endorsement Sheet

    Загружено:

    Mon Doce
    121 просмотров1 страница

    Оригинальное название

    Endorsement Sheet.docx

    Авторское право

    © © All Rights Reserved

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    121 просмотров1 страница

    Endorsement Sheet

    Загружено:

    Mon Doce

    Авторское право:

    © All Rights Reserved
    Скачайте в формате DOCX, PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    из 1

    Room #: ________ Room #: ________ Room #: ________ Room #: ________ Room #: ________

    Name of Pt.:_____________________ Name of Pt.:_____________________ Name of Pt.:_____________________ Name of Pt.:_____________________ Name of Pt.:_____________________
    Age: ________ Age: ________ Age: ________ Age: ________ Age: ________
    Physician: Dr. ____________________ Physician: Dr. ____________________ Physician: Dr. ____________________ Physician: Dr. ____________________ Physician: Dr. ____________________
    Dr. ____________________ Dr. ____________________ Dr. ____________________ Dr. ____________________ Dr. ____________________
    CC:_____________________________ CC:_____________________________ CC:_____________________________ CC:_____________________________ CC:_____________________________
    _____________________________ _____________________________ _____________________________ _____________________________ _____________________________
    V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________
    Diet: ______________________ Diet: ______________________ Diet: ______________________ Diet: ______________________ Diet: ______________________
    Special Endorsements: Special Endorsements: Special Endorsements: Special Endorsements: Special Endorsements:

    Other Contraptions: Other Contraptions: Other Contraptions: Other Contraptions: Other Contraptions:

    IV #: ____, with __________________ IV #: ____, with __________________ IV #: ____, with __________________ IV #: ____, with __________________ IV #: ____, with __________________
    at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr

    Room #: ________ Room #: ________ Room #: ________ Room #: ________ Room #: ________
    Name of Pt.:_____________________ Name of Pt.:_____________________ Name of Pt.:_____________________ Name of Pt.:_____________________ Name of Pt.:_____________________
    Age: ________ Age: ________ Age: ________ Age: ________ Age: ________
    Physician: Dr. ____________________ Physician: Dr. ____________________ Physician: Dr. ____________________ Physician: Dr. ____________________ Physician: Dr. ____________________
    Dr. ____________________ Dr. ____________________ Dr. ____________________ Dr. ____________________ Dr. ____________________
    CC:_____________________________ CC:_____________________________ CC:_____________________________ CC:_____________________________ CC:_____________________________
    _____________________________ _____________________________ _____________________________ _____________________________ _____________________________
    V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________ V/S q: ___________ I&O q: _________
    Diet: ______________________ Diet: ______________________ Diet: ______________________ Diet: ______________________ Diet: ______________________
    Special Endorsements: Special Endorsements: Special Endorsements: Special Endorsements: Special Endorsements:

    Other Contraptions: Other Contraptions: Other Contraptions: Other Contraptions: Other Contraptions:

    IV #: ____, with __________________ IV #: ____, with __________________ IV #: ____, with __________________ IV #: ____, with __________________ IV #: ____, with __________________
    at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr at ________ gtts/min or cc/hr

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