Name: _________________________________ Age: ____ Sex: ____ Civil Status: ____

Date Admitted: ________________ Address: ______________________Religion: _____

Attending Physician: _____________________ Chief Complaint: __________________
Admitting Diagnosis: _________________________ Diet: _________ Room No. _____
Case No. _________ Membership: _________ Date of Birth: ______________________

Date Treatment Medications IVF

11-30-09 >TPR q Shift >Paracetamol 325\tab 1 tab q >#1 D5.03
>Labs: CBC, Plt, U\A 4 for fever Nacl 1 L @
>V\S q 2 & Record >Ampicillin 500 mg IVTT q 100 cc\hr
>Repeat Plt, Hct, Tom AM 6 ANST >#2 D5NSS 1
@ lab >Paracetamol 200\5 mL 1 tsp L + 1 amp
>Refer for persistent q4 PRN for fever BNC @ SR-
epistaxis & other >Paracetamol 300 mg IVTT available
unusualities now then PRN for T>39 C
Name: _________________________________ Age: ____ Sex: ____ Civil Status: ____
Date Admitted: ________________ Address: ______________________Religion: _____
Attending Physician: _____________________ Chief Complaint: __________________
Admitting Diagnosis: _________________________ Diet: _________ Room No. _____
Case No. _________ Membership: _________ Date of Birth: ______________________

Date Treatment Medications IVF

11-28-09 >VS q 4 > Lanoxin 25 mg ½ tab OD >#1 PNSS 1 L
>Labs: >NaHCO3 325 mg 1 tab OD @ KVO rate
RBS, CBC, U\A, ECG, >K 1 tab TID >#2 PNSS 1 L
CXR-PA, FBS, Na., K., >Vit. B Complex 1 tab q 12 + 100cc NaCl
SUA >Celecoxib 200 mg 1 cap @ 20 gtts/min
>CBR w/o BRP BID
>Will inform AP >Domperidome10 mg 1 tab
>Refer to M. Lasala for co- TID
mgt >Endostine 1 cap BID
>R.A. >Plasil 1 amp IV now
11-29-09 >For Endoscopy
>(+) Vomiting
>(+) on\off epigastric pain
>(+) anemia
>schedule for UGI
endoscopy now c/o GMCH

11-30-09 >maintain in NPO

Dr. Gay Hernandez for
sedation
Facilitate transfer ASAP
inform M. Molina
Name: _________________________________ Age: ____ Sex: ____ Civil Status: ____
Date Admitted: ________________ Address: ______________________Religion: _____
Attending Physician: _____________________ Chief Complaint: __________________
Admitting Diagnosis: _________________________ Diet: _________ Room No. _____
Case No. _________ Membership: _________ Date of Birth: ______________________

Date Treatment Medications IVF

11-30-09 >Admit under Dr. Balazo
>High Caloric Diet
>TPR q Shift
>Labs: CBC, U/A, CXR-
PA view- Follow up result
>Retrieve chart of previous
admission
>inform AP
>Dilantin 100/ tab 1 tab TID >#1 D5W
>Combivent Now q 8 500cc @ KVO
>Cefurexime 80 mg IVTT q
8 ANST
>Essentiale forte 1 tab TID