MRD Checklist

ALL PATIENT
SR. NO. IPD RESPONSIBILITIES
1. ADMISSION RECORD ADMISSION/ RECEPTIONIST
2. GENERAL INFORMED CONSENT ADMISSION/ RECEPTIONIST
3. INITIAL COUNSELING FORM ADMISSION/ RECEPTIONIST
4. रुग्णांच्या मौल्यवान वस्तूंचे हस्तांतरण पत्र NURSE
4.A रुग्णाने द्यावयाची माहिती PATIENT OR RELATIVE
5. INITIAL ASSESSMENT FORM DOCTOR
6. NUTRITIONAL ASSESSMENT FORM NURSE/ DOCTOR
7. DOCTORS ORDER SHEET DOCTOR
8. NURSES DAILY RECORDS NURSE
9. DRUG ADMINISTRATION FORM DOCTOR/NURSES
10. TPR CHART NURSE
11. DISCHARGE CARD SUMMARY DOCTOR
12. PATIENT FEEDBACK FORM - IPD/OPD ADMISSION/ RECEPTIONIST

When Patient is for surgical Procedure

Sr. No. IPD Responsibilities
12. INFORMED CONSENT FOR ANESTHESIA Nurse
13. INFORMED CONSENT FORM FOR SURGERY/PROCEDURE Nurse/ Doctor
14.a PRE OPERATIVE FITNESS ASSESSMENT BY PHYSICIAN Doctor
14.b PRE OPERATIVE FITNESS ASSESSMENT BY PEDIATRICIAN Doctor
15. PRE OPERATIVE ASSESSMENT BY ANESTHETIST Doctor
16. PRE - OPERATIVE CHECKLIST NURSE Nurse / OT Assistant
17. INTRA OPERATIVE ANESTHESIA EVALUATIONS Doctor/ Anesthesia
18. POST OPERATIVE CHECK LIST Doctor/ Anesthesia
19. OPERATIVE NOTES BY SURGEON Doctor
20. POST ANESTHESIA OBSERVATION AND INSTRUCTIONS Doctor/ Anesthesia
21. HISTOPATHOLOGY Doctor
22. INFORMED CONSENT FORM FOR HIV ANTIBODIES TEST Doctor/ Nurse
23. SURGICAL SITE CHECKLIST Nurse

Formats As and Required

Sr. No. IPD Responsibilities
24. INFORMED CONSENT FOR TRANSFUSION OF BLOOD/ BLOOD COMPONENTS NURSE
25. BLOOD AND BLOOD PRODUCT TRANSFUSION RECORD DOCTOR/ NURSE
26. CRITICAL CARE CHART NURSES
27. HIGH RISK CONSENT DOCTOR/ NURSE
28. REFUSAL OF TREATMENT PATIENT /RELATIVE
29 THROMBOLYSIS CONSENT FORM STANDARD FORMS-
30. INFORMED CONSENT FORM FOR DIALYSIS DOCTOR/ NURSE
31. INFORMED CONSENT FOR MINOR PROCEDURES DOCTOR/ NURSE
32. INFORMED CONSENT FORM FOR ENDOSCOPY DOCTOR/ NURSE
33. INFORMED CONSENT FOR PHYSIOTHERAPY TREATMENT DOCTOR/ NURSE
34. DAMA/LAMA DISCHARGE CONSENT DOCTOR/ NURSE
35. CHEMOTHERAPY DOCTOR/ NURSE
36. TRANSFER REFERRAL FORM DOCTOR/ RECEPTION