• Name:
    first_name.' '.$datas->last_name?>
  • Birth:
    dob?>
  • Email:
    patient_email?>
  • Contact:
    cellphone?>
  • Gender : gender?>
  • Merital : marital_stat?>
  • Weight : weight?>
  • Direction : direction?>
  • #Soc Sec No : soc_sec_no?>
  • Address:
    address?>
  • Height : height?>
  • Billing address : alt_billing_address?>

Patient Visit Record

  • Date :date; ?>
  • dayday; ?>
  • Time intimeIn; ?>
  • Time outtimeOut; ?>
  • Patients NamepatientName; ?>
  • Date of Birthdob; ?>
  • Diagnosisdiagnosis; ?>
  • Allergyallergy; ?>
  • MDmd_name; ?>
  • Id Confirmedid_confirmed; ?>
  • ReasonReason; ?>
  • Types Of Device Accesstypes_of_device_access; ?>
  • Access AssessmentaccessAssessment; ?>
  • Actionaction; ?>
  • Tapertaper; ?>
  • Program Verified Withprogram_verified_with; ?>
  • Bolusbolus; ?>
  • Pump bettery chargepump_bettery_change; ?>
  • Pump Res Volumepump_res_volume; ?>
  • Pump Ratepump_rate; ?>
  • pump_rate; ?>pumpRateValue; ?>
  • KVOKVO; ?>

PHYSICAL ASSESSMENT

  • VITAL SIGNSvital_signs; ?>
  • Vital Signs Measurementsvital_signs_measurment; ?>
  • CARDIOVASCULARcardiovascular; ?>
  • NotescardiovacularNotes; ?>
  • RESPIRATORYRESPIRATORY; ?>
  • Notesrespiratory_notes; ?>

FOODS/FLUIDS

Diet foods; ?>
Fluid fluid; ?>
Fluid Intake fluid_intake; ?>
Weight Amount weight; ?>
Comments fl_comments; ?>

ENDOCRINE

ENDOCRINE endoCrine; ?>
Diabetes diabetes; ?>
Comments bs_comments; ?>

ACTIVITY/REST

ACTIVITY/REST activity_rest; ?>
Musculosketal musculosketal; ?>
Activity mus_activity; ?>
Encouraged PROM exercises to extremeties encourage_p_rom_exa_extrimist; ?>
Ambulatory ambulatory; ?>
Dependent dependent; ?>
wheelChair wheelChair; ?>
Comments arComment; ?>

PAIN

PAIN pain; ?>
Pain level assessed pain_level_assessed; ?>
Type pla_type; ?>
Quality pla_quality; ?>
Relief From relief_from; ?>

SKIN

SKIN skin; ?>
Describe sk_describe; ?>
Bruises Location bruises_location; ?>
Surgical Site surgikal_site; ?>
Wound wound; ?>
Comments woundcomment; ?>

CIRCULATION

Chest Pain circulation; ?>
Edema edema; ?>
Location edema_location; ?>
Peripheral Capillary Refill peripheral_capilary_refil; ?>
Circulation Status circulation_status; ?>
Comments circulationStat_comment; ?>

VENTILATION

VENTILATION ventilation; ?>
Ventilator Type ventilator_type; ?>
Breath Sounds breathSound; ?>
SOB sob; ?>
Color color; ?>
Ventilator Settings ventilator_setting; ?>
Ventilator Mode ventilator_mode; ?>
Ventilator TV ventilatortv; ?>
Ventilator Pressure ventilatorPressure; ?>
Ventilator BR ventilatorBR; ?>
Ventilator Oxygen Mesured In L/Min ventilatorOxygenMeasure; ?>
Inspiratory Time inspiratory_time; ?>
Oximeter Frequency circulationStat_comment; ?>
Oximeter Paramteres oxymeterParameterNotes; ?>
Other oxOtherNotes; ?>

TRACHEOTOMY CARE

TRACHEOTOMY CARE tracheotomy_care_required; ?>

MD Orders

Notes mdOrders; ?>
Trach Excoriation trachExcorition; ?>
Notes teNotes; ?>
Trach Drainage TrachDrainage; ?>
Notes TrachDrainageNotes; ?>
Redness At Trach Site rednessAtTrachSite; ?>
Notes ratsNotes; ?>
Trach Inner Cannula Changed trachInnerCannualChange; ?>
Notes ticcNotes; ?>
Trach Connector Size trachConnectorSize; ?>
Trach Connector Length trachConnectorlength; ?>
Trach Suction trachSuction; ?>
Notes tsNotes; ?>
Trach Suction Type trachSuctionType; ?>
Trach Suction Catheter Kit trachSuctionCatheterKit; ?>
Trach Suciton Catheter Kit Size trachSuctionCatheterKitsizes; ?>
Notes trachSuctionNotes; ?>

GASTROINTESTINAL

  • Gastrointestinal gastrointestinal; ?>
  • Date of Last Bowel Movement dateOflastBowelMoment; ?>
  • CommentsdateOflastBowelMoment; ?>

GENITOURINARY

GENITOURINARY genitourinary; ?>
Color genitourinaryColor; ?>
Cathertar catheter; ?>

HYGINENE

Hyginene hyginene; ?>
Hyginene Comment hygineneComment; ?>

INTEGUMENTARY

INTEGUMENTARY integumentary; ?>
Color Vairables ColorVairables; ?>
Temperature Variables TemperatureVariables; ?>
Turgor Variables TurgorVariables; ?>
Notes TurgorVariablesComment; ?>

NERUOLOGICAL

NERUOLOGICAL neurological; ?>
Status neuroStatus; ?>
Activity neuroActivity; ?>
Notes neuroComment; ?>

PSYCHOLOGICAL / EMOTIONAL REACTION

Social Support System phychologicalEmotionalReaction; ?>
Copes Effectively with Therapy CopesEffectivelywithTherapy; ?>
Copes Effectively with Disease CopesEffectivelywithDieases; ?>
Notes physicalEmotionalComments; ?>

SKILLS - KNOWLEDGE ASSESSMENT

TEACHING skillKnowTeaching; ?>
Notes skillKnowComments; ?>
LEARNING skillKnowLearning; ?>
Notes skillKnowLearningComment; ?>

RESPONSE TO THERAPY

Adverse Medication Side Effects phychologicalEmotionalReaction; ?>
Patient Complain with Medication Thearpy CopesEffectivelywithTherapy; ?>
Notes CopesEffectivelywithDieases; ?>
Caregiver physicalEmotionalComments; ?>
Copes Effectively, with Therapy or Disease process physicalEmotionalComments; ?>

MEDICATION

Medication Changes MedicationChanges; ?>
Review Medication Profile Include Otc ReviewMedicationProfileIncludeOtc; ?>
New Meds NewMeds; ?>
Changes & Effects Reviewed with ChangesEffectsReviewedwith; ?>
Caregiver medicationCaregiver; ?>
Use Of Pump useOfpump; ?>
Prepour Medications By PrepourMedicationsBy; ?>
Job Title JobTitle; ?>
Patient Independent In Medication Administration PatientIndependentInMedicationAdministration; ?>
LOT# lot; ?>
Expiration Date expirationDate; ?>

RESPONSE TO THERAPY

Adverse Medication Side Effects adverseMedicationSideEffects; ?>
Patient Complain with Medication Thearpy PatientComplainwithMedicationThearpy; ?>
Notes responseTherapyComment; ?>
Caregiver responseTherapyCaregiver; ?>
Copes Effectively, with Therapy or Disease process Copes_Effectively_with_Therapy_or_Disease_process; ?>

EQUIPMENT

EQUIPMENT equipment; ?>
Enviornmental Safety EnviornmentalSafety; ?>
Safety Concernss updatePassword; ?>
WOUND CARE woundCare; ?>