NAME: DATE: IMC J1/J3 IPC J5N MH1 MH2 MH3
Notes: Admission done by: Senior: Intern: M
IS THIS YOUR 10TH H&P, IF YES CALL BACK-UP. A
H
1 2
ADMITTED TO: MAHA # WARD # NT
PLACE Floor: Attending: OBS
A
1 3 4
H&P Consult Code RRT Other M
STICKER HERE Why pt became non-teaching:
A
H
1 2
A
2 3 4
Time Pt. ED Pertinent M
notified of location: studies A 1
admission: completed? H
A
yes no 3 2
Notes: Admission done by: Senior: Intern: M
IS THIS YOUR 10TH H&P, IF YES CALL BACK-UP. A
1 2
H
ADMITTED TO: MAHA # WARD # NT
PLACE Floor: Attending: OBS
A
1 3 4
H&P Consult Code RRT Other M
STICKER HERE Why pt became non-teaching:
A
H
1 2
A
2 3 4
Time Pt. ED Pertinent M
notified of location: studies A 1
admission: completed? H
A
yes no 3 2
Notes: Admission done by: Senior: Intern: M
IS THIS YOUR 10TH H&P, IF YES CALL BACK-UP. A
H
1 2
ADMITTED TO: MAHA # WARD # NT
PLACE Floor: Attending: OBS
A
1 3 4
H&P Consult Code RRT Other M
STICKER HERE Why pt became non-teaching:
A
H
1 2
A
2 3 4
Time Pt. ED Pertinent M
notified of location: studies A 1
admission: completed? H
A
yes no 3 2
Notes: Admission done by: Senior: Intern: M
IS THIS YOUR 10TH H&P, IF YES CALL BACK-UP. A
H
1 2
ADMITTED TO: MAHA # WARD # NT
PLACE Floor: Attending: OBS
A
1 3 4
H&P Consult Code RRT Other M
STICKER HERE Why pt became non-teaching:
A
H
1 2
A
2 3 4
Time Pt. ED Pertinent M
notified of location: studies A 1
admission: completed? H
A
yes no 3 2
Notes: Admission done by: Senior: Intern: M
IS THIS YOUR 10TH H&P, IF YES CALL BACK-UP. A
1 2
H
ADMITTED TO: MAHA # WARD # NT
PLACE Floor: Attending: OBS
A
1 3 4
H&P Consult Code RRT Other M
STICKER HERE Why pt became non-teaching:
A
H
1 2
A
2 3 4
Time Pt. ED Pertinent M
notified of location: studies A 1
admission: completed? H
A
yes no 3 2