Plan of care

1. PLAN OF CARE Date: StudentName:
Outcome Patient1 Outcome Patient2 Outcome Patient3 Outcome Patient4 Outcome Patient5
Allergies____________
Code Status_________
IV _____________ ml/hr
Activity_____________
Diet________________
Drains______________
VS_________________
Glucometer__________
Dressing_____________
Output______________
02 __________________
LBM ________________
Dx:
Med Hx:
Allergies____________
Code Status _________
IV _____________ ml/hr
Activity_____________
Diet________________
Drains______________
VS_________________
Glucometer__________
Dressing_____________
Output______________
02 __________________
LBM ________________
Dx:
Med Hx:
Allergies____________
Code Status_________
IV _____________ ml/hr
Activity_____________
Diet________________
Drains______________
VS_________________
Glucometer__________
Dressing_____________
Output______________
02 __________________
LBM ________________
Dx:
Med Hx:
Allergies____________
Code Status_________
IV _____________ ml/hr
Activity_____________
Diet________________
Drains______________
VS_________________
Glucometer__________
Dressing_____________
Output______________
02 __________________
LBM ________________
Dx:
Med Hx:
Allergies____________
Code Status_________
IV _____________ ml/hr
Activity_____________
Diet________________
Drains______________
VS_________________
Glucometer__________
Dressing_____________
Output______________
02 __________________
LBM ________________
Dx:
Med Hx:
ReportInfo: ReportInfo: ReportInfo: ReportInfo: ReportInfo:
Assessmentfindings: Assessmentfindings: Assessmentfindings: Assessmentfindings: Assessmentfindings:

2. Labs and Meds:
Pt: 1 Pt: 2 Pt: 3 Pt: 4 Pt: 5
Planof Care: Meds: Planof Care: Meds: Planof Care: Meds: Planof Care: Meds: Planof Care: Meds:
0700 0700 0700 0700 0700
0800 0800 0800 0800 0800
0900 0900 0900 0900 0900
1000 1000 1000 1000 1000
1100 1100 1100 1100 1100
1200 1200 1200 1200 1200
1300 1300 1300 1300 1300
1400 1400 1400 1400 1400
1500 1500 1500 1500 1500
1600 1600 1600 1600 1600
1700 1700 1700 1700 1700
1800 1800 1800 1800 1800
1900 1900 1900 1900 1900
SignificantLabValues: SignificantLabValues: SignificantLabValues: SignificantLabValues: SignificantLabValues: