IM‎ > ‎

AdmissionNotes

Admit to: Tele or GMF
     Attending:
     Intern:
Diagnosis:
Condition: Fair
Vitals: Routine
Activity: Ad Lib
Nursing: Routine
Diet: Cardiac / Diabetic
IVF: Hep Lock or NS
Meds: See purple sheet
Allergies:
Labs:  TSH, UTox, AM Labs CBC, BMP
Special: Thyroid U/S ind: multinodular goiter
Code: Full
d/ something: Dr. Flannery

Intern Signature, Pager
Intern Name

- Atypical Chest Pain
R/O ACS
PNA / pleuritic chest pain
GERD
Anxiety
Obesity
- Diagnostic Plan
Stress Test AM, CBC w/ Diff, BMP, PT, PTT, INR
Cardiac Enz x3 q6hr, Lipid Profile, TSH (maybe)
- Therapeutic Plan
ASA 81 mg PO QDay, Pantoprazole 40mg PO QDay
Nicotine Patch change Q Day
- Remember to inquire DNR/DNI

Comments