General Report (make copies for multiple Pts)

General Report (make copies for multiple Pts)

Name                                  Age                              Sex                                             Rm #

Diagnosis

Code Status

Admit Date                         Dr.

Surgery Procedure

Neurologic

Respiratory

CV

GI-GU

MS

Pain

Skin

Incision-Dressing

I & O

IVs                                      LTC

Diet-NPO

Activity

Labs-Procedures

Miscellaneous

D/C Planning-Teaching Needs