Patient Medical Record

Patient Info

Name:

Age:

Gender

Hosp No:

Diagnosis:

Principle Diagnosis:

V/B:

No V V (STDBY)
B B (STDBY) B (NOCT)
HF O2

SVS

Yes No

Fall Risk:

No MFS 25-50 MFS ≥ 50

Vitals:

BP	/	GCS	/15
SpO₂		Litre of O₂
Pulse		Temp

Infection Precaution:

Contact
Droplet
Airborne
  MRSA
  MDRA
  CPE
  VRE

Tier:

Admission Info

Ward

Sub Specialty:

Bed No:

Admission Date:

:

Transfer In Date:

:

Team

Case

Source

Change Bed

Swap Bed with Another Patient

EDD

HDC
	Set To Current Time Clear Time

Discharge Patient
Mode of Discharge:	Transfer Out Reb Hospital Other Hospital Home Death DAMA Walk Away Missing
Relative Informed	Yes No
NEATS	Yes No
All Ready for NEATS	Yes No
Follow Up	Arranged Scheduled Nil
Discharge Date / Time:	Set To Current Time Clear Time