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DATE _________________________________________________ Time _____________________________________
1. Admit to Service of ______________________________________________________________
2. Allergies: ____________________________________________________________________________________
3. Admit to:
4. Diagnosis:
Additional Diagnoses: ___________________________________________________________________________ 5. Condition:
6. Code Status:
7. Nursing Documentation:
Other______________________________________ Daily Weights (kg) / I&O and record on admission and daily. Saline lock or IV fluids: ____________________________________________________________________ 9. Activity:
10. Diet:
11. Fluids:
Fluid Restriction _________________ml/day 12. Medication Choices:
Pharmacy to dose all medication for creatinine clearance. Ceftriaxone (Rocephin) 1 gram IV every 24 hours and Doxycycline 100mg every 12 hours
Other ________________________________________________________________ Other ________________________________________________________________ Acetaminophen 650 mg orally every 4 hours prn temp greater than 100.5 F or mild pain / headache not to Other______________________________________________________________________ Milk of Magnesia 1-4 tablespoons orally every day – titrate to soft stools Other__________________________________________________________ Other_________________________________________ Other_________________________________________ Continued on page 2
8761-EH03 (12-16-08)

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Other : _______________________________________________________________________________________ Other : _______________________________________________________________________________________ Other : _______________________________________________________________________________________ Other : _______________________________________________________________________________________ Other : _______________________________________________________________________________________ Other : ________________________________________________________________________________-______
14. Diagnostic Studies:
15. Admit Lab:
Blood Cultures x2, 15 minutes apart from different sites, prior to antibiotics Sputum gram stain and culture. If patient not able to provide sample within 15 minutes, RT to induce with 2.5 mg Albuterol in 2.5cc normal saline. If patient cannot provide a sample within 30 minutes, consider nasal Other ____________________________________________________________________________ 16. Lab in AM: _______________________________________________________________________________________

17. Respiratory:
O2 __________________________________________________________ SVN with Albuterol + 2.5 mg QID / PRN or
SVN with/2.5 mg Albuterol + 0.5 mg Atrovent QID / PRN Advair 100/50 1 click every am or
Other: ________________________________________________________________________________________
18. Assessments/Consultations:
Other ___________________________________________ Smoking cessation counseling/education if patient smoked in last year 19. Discharge planning:
_______________________________________________________________________________________ Physician’s Signature PATIENT LABEL


New York, NY 10019 T.646.281.9596 | EUBIN KIM EDUCATION New School University New York, NY Masters of Arts in Media Studies and Film Concentration in broadcast video production and conceptual design The Cooper Union for the Advancement of Science and Art New York, NY  Recipient of four-year ful tuition scholarship EXPERIENCE

Microsoft word - 2008 july 30 minutes

Mill Site Study Committee Present: Committee Members: Kurtis Amidon, Jerrilyn Bozicas, Stephanie Cronin, Roger Goscombe, Albert Harris, Ronald Karr, Michael Landino, Matt Nesbit, Jeff Sauer, Joseph Sergi, and Stephen Themelis Members absent: Jeffrey Chabot and Gary Giguere Also present: Jay Donovan (Assistant Director, NMCOG) The Committee attended a site visit at the Mill Site

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