Template Information
Use this report sheet to obtain a complete record of a critical care patient in the icu. it contains 83 line items which ask for essential medical information. these findings are important for doctors and physicians to determine the medical procedures needed by the patient.
Category: general
Template Questions
- Admit date Date
- Reason
- Situation:
- Safety
- Isolation
- Background:
- PMH
- Psychosocial
- Decision Maker
- NOC T-Max
- Day T-Max
- Neuro
- RASS
- GCS
- EF
- Rhythm
- Echo date Date
- Hemodynamics
- Respiratory
- P/F Ratio
- Vent Settings
- GI
- Diet
- GU
- NOCS:
- In Date
- Out Date
- DAYS:
- Fluid Balance
- Condition
- Skin
- Procedure
- Please provide details
- Immune System
- IV Sites
- Please enter details
- Sepsis
- Lactate
- CVP
- ScVO2
- Click + to add Abx
- Abx
- Given at
- Lab Draws
- Accu-Check
- Parameters
- PRNs Given
- Please provide your recommedations
- Full Name and Signature of Nurse Attendee