Physician Order Sheet
Patient Name:    ADMIT to WMH

Time & Date

Another generically equivalent product identical in dosage form and content of active ingredient may be administered unless otherwise indicated. Only items checked in check boxes are orders. Empty Check Boxes are not ordered items.
 D:   Diagnosis:
 T:   Allergies:
   Code Status:
   Vital Signs: Routine 
   Diet:     If ADA diet: cal/day
   Activity:
 
Begin Cardiac Rehab Phase I Weights: 
 
Flowtrons TEDS - knee high Other:

LAB/STUDIES:

 CBC   CMP   U/A   PT   PTT   T4   TSH           MI Panel on admission,then Q 6 hours x 3
  Fasting Lipid Panel in AM  Urine Culture   Blood Culture x       ABG     O2Sat
  Accucheck             EKG  x                 
  AM Lab Following Day:
  Echocardiogram - Reason: to read
  CXR - CT SCAN-Loc + Reason:
  OTHER TESTS:

 RESPIRATORY:

Oxygen  

  

 PT/OT/Speech:

PT Evaluation and Treatment      OT Evaluation and Treatment      Speech Evaluation and Treatment

OTHER SERVICES:

 Social Service Consult    Chaplain Visitation Requested    Northwestern Evaluation             (see progress notes)

STANDING MEDS:

 Tylenol 650mg PO PR q4h prn T>101 or H/A/Pain Laxative of Choice prn constipation
   Darvocet N-100 PO q4h prn pain or H/A Phenergan q6h prn N and/or V

  

 Restoril 15mg QHS prn Sleep Nitroglycerin .4mg SL q 5 min x 3 prn chest pain

 

 IV:@cc's per Hour.  IV ADDITIVES:
  Sliding Scale Humulin R: Dose = (Accucheck BS - 100) / Q 6 Hours. Don't Rx if BS < 200 mg/dl

OTHER ORDERS:

 
 
 
 
 
  SIGNATURE:

Attending Physician: 

Genesis 9/00

Original to Chart, Copies to Pharmacy and Nurse

Patient Identification Label