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

Chinese Meds (中)

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 +VE
  PDRA +VE
  MDRA +VE
  CPE +VE
  VRE +VE

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

DMC
	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 Relative contacted:
NEATS	Yes No
All Ready for NEATS	Yes No
Follow Up	Arranged Scheduled Nil
Discharge Date / Time:	Set To Current Time Clear Time