Request for Admission

Admitted Under

Dr.Sumit Singh

Vulnerability Assessment

Level of Consciousness :	UnConscious
Dependency :	Independent
Mode of Movement :	Self
Vulnerability Assessment/ Triage :	Urgent_Care
Pain Assessment :	/10
Pain Location :

Fall Risk

High fall risk:	Yes
History of more than one fall within 6 months before admission:	Yes
Patient has experienced a fall during the hospitalization:	Yes
Patient is deemed high fall-risk per protocol such as seizure precaution:	No

Created & Updated

By :Abhay Kumar

At : 2024-09-13

 

Prescription

Level of Consciousness :	UnConscious
Vulnerability Assessment :	Urgent_Care
Pain Assessment :
Pain Location :

Vitals

SPo2(%)	RBS(mg/dl)	Temp(C*)	Pulse(Min)	BP(mmHg)

BMI Result

24000

Admission diagnosis	Note	Eye

Visual Acuity Test	Right Eye	Left Eye

Glass Advices Distance	Right Eye	Left Eye

Glass Advices Near	Right Eye	Left Eye

Examination	Right Eye	Left Eye

Investigation

Date Time	Investigation	Result	Evidence (Upload)

Rx

Drug & Dose	Route	Note	Frequency	Duration