Beruflich Dokumente
Kultur Dokumente
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[B NEG]
[B NEG]
Wristband #:
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[B POS]
[B POS]
Wristband #:
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[A NEG]
[A NEG]
Wristband #:
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[A POS]
[A POS]
Wristband #:
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[AB NEG]
[AB NEG]
Wristband #:
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[AB POS]
[AB POS]
Wristband #:
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[O NEG]
[O NEG]
Wristband #:
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________
Patient Unit #:
Patient Name:
Date of Birth :
Patient Phys :
Hosp, Location:
Lab Specimen#:
012221
Account #: IN000000/04
John Smith
06/29/1951
DOOLITTLE, DR
4B
426-1
ADM IN
0808:BB00001U
[O POS]
[O POS]
Wristband #:
BLOOD COMPONENT
ISSUE/ADMINISTRATION
RECORD
R1234
Lot#: 567392
Received: 4/30/13 1700
Compatible: Y 05/08/13
VITAL SIGNS
Pre Administration:
Time: _________________________
BP:_____ T:_____ P:_____ R:_____
During Administration:
Time
BP
Init
Comments: After transfusion is finished, return the yellow copy of this form
together with segments and yellow tags (if red cell product), to the
Blood Bank. Return product within 20 min. if Transfusion cannot be
started. If a reaction occurs, return all units to Blood Bank.
*COMPLETE THE FOLLOWING WHEN PRODUCT TRANSFUSED*
Product arrived at Nursing Unit on Date: _________ Time: ________
Time Transfusion Started: __________ Ended: __________
Volume Transfused: ____________
Administered by: __________
Comments: _____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
____________________________