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Ria Laelasari (El)

Janice Smith, a 17-year-old female student, was admitted to the emergency unit of the hospital on October 13, 2022 at 2:56 pm via stretcher with no orientation to her environment. She has been experiencing pharyngitis for 4 days and is allergic to shrimp and penicillin. Her vital signs and medical history were recorded upon admission.

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momon
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38 views1 page

Ria Laelasari (El)

Janice Smith, a 17-year-old female student, was admitted to the emergency unit of the hospital on October 13, 2022 at 2:56 pm via stretcher with no orientation to her environment. She has been experiencing pharyngitis for 4 days and is allergic to shrimp and penicillin. Her vital signs and medical history were recorded upon admission.

Uploaded by

momon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CANADA'S HOSPITAL CENTER

ADMISSION FORM

Hospital Reg. No Unit Adm. Date Adm. Time


01.32.33.45.89 Emergency Unit 10/13/2022 14:56
Complete Name First Name Family Name ID No.
Janice Smith Janice Smith 32110877635672800
Age (DOB/POB) Sex Religion Marital Status Occupation
17 ( )M ( V )F Islam ( )M ( V )S ( )W ( )Wr Student
Transport Mode ( ) WC ( ) Walking ( V ) Strechers ( ) Other
Oriented to Environment ( ) Yes ( V ) No
Permanent Address

Cadburry Street No.01 West Rock, Canada

Zip Code 564311 Phone No


Name & Address of Next Kin
Johnson Smith
Cadburry Street No.01 West Rock, Canada

Zip Code 564311 Phone No. 0765-84995231


Relationship Father
Allergic Yes ( V ) Food : Shrimp ( V )Meds/Other : Penicillin
Admitting Vital Sign Temp Pulse Respiration B/P Weight/Height
10/14/2022 37.5 89 17 110/70 45 Kg/165 cm

HEALTH HISTORY
Current Medication Last Dose Cardiac Medication Last Dose
Amoxil 3 X 500 mgs No
FG Throches 2 X 1 Tab
Panadol 3 X 500 mgs

PAST MEDICAL & SURGICAL HISTORY Complete By Date


Pharyngitis for 4 days Nurse Riri 10/13/2022

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