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    Assesment Print - PHP

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    ganisaheb.1982iam
    Mr. Botta Murali Krishna, a 50-year-old male, presented to City Clinic International with a chief complaint of injury. His vital signs were stable with a temperature of 36.1 C, pulse of 72, BP of 140/80, and SpO2 of 99%. He arrived ambulatory without signs of neglect, abuse, or pain. Screening found no risk of falls, normal nutrition, self-care ability, and ambulatory function. His medical history and home medications were noted for physician review. Immunizations were complete for his age.

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    Assesment Print - PHP

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    ganisaheb.1982iam
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    Mr. Botta Murali Krishna, a 50-year-old male, presented to City Clinic International with a chief complaint of injury. His vital signs were stable with a temperature of 36.1 C, pulse of 72, BP of 140/80, and SpO2 of 99%. He arrived ambulatory without signs of neglect, abuse, or pain. Screening found no risk of falls, normal nutrition, self-care ability, and ambulatory function. His medical history and home medications were noted for physician review. Immunizations were complete for his age.

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    Mr. Botta Murali Krishna, a 50-year-old male, presented to City Clinic International with a chief complaint of injury. His vital signs were stable with a temperature of 36.1 C, pulse of 72, BP of 140/80, and SpO2 of 99%. He arrived ambulatory without signs of neglect, abuse, or pain. Screening found no risk of falls, normal nutrition, self-care ability, and ambulatory function. His medical history and home medications were noted for physician review. Immunizations were complete for his age.

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    © All Rights Reserved
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    20 views2 pages

    Assesment Print - PHP

    Uploaded by

    ganisaheb.1982iam
    Mr. Botta Murali Krishna, a 50-year-old male, presented to City Clinic International with a chief complaint of injury. His vital signs were stable with a temperature of 36.1 C, pulse of 72, BP of 140/80, and SpO2 of 99%. He arrived ambulatory without signs of neglect, abuse, or pain. Screening found no risk of falls, normal nutrition, self-care ability, and ambulatory function. His medical history and home medications were noted for physician review. Immunizations were complete for his age.

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    of 2

    City Clinic International Patient Name: BOTTA MURALI

    KRISHNA
    Outpatient Initial Nursing Mr No: FAH202322943
    Assesment Form Age 50 Sex MALE
    Vital Signs
    Temperature 36.1
    INSTRUCTIONS:
    Pulse 72
    1. Tick(/) appropriate boxes/ Fill in appropriate information as required/ requested and N/A for not Spo2 99
    applicable Systolic BP 140
    Diastolic BP 80
    2. Notify Physician For any abnormalities noted Height
    3. Completes Form upon arrival to the Clinic Weight
    RR
    HC
    GRBS
    Mode of Arrival/Transportation
    Ambulatory Wheel Chair Trolley Others : Specify:

    General Appearance
    Active In distress Sign of Neglect or Others ,Specify:
    Abuse

    Allergies
    No Not known Yes,specify:

    Interpreter
    Yes No

    Pain Screening -Presence Of Pain


    No Yes,pain Score:

    Notify Physician
    Yes No Invention Any

    Outpatient Fall Risk Screening & Intervention:


    History of Fall Gait Disturbance Visual Impairment Altered Mental Status

    Is the Patient Susceptible to Fall


    No If Yes Follow Fall Inform Family to call use Wheel keep under constant

    Precaution Specific in OPD for help assist on and off Chair/Stretcher with safety supervision

    the examination table srap and brakes

    Nutritional Screening:
    BMI: Normal Overweight Obesity

    Morbid Obesity Underweight

    Social Screening:
    Selfcare Care by family Community Facility Caretaker

    Any concern:

    Functional Screening:
    Ambulatory Bedridden Uses Devices Ambulatory with

    Assesment Done By :-BRAYOLJIN Date And Time :-14/12/2023 01:08 PM


    City Clinic International Patient Name: BOTTA MURALI
    KRISHNA
    Outpatient Initial Nursing Mr No: FAH202322943
    Assesment Form Age 50 Sex MALE
    Vital Signs
    Temperature 36.1
    INSTRUCTIONS:
    Pulse 72
    1. Tick(/) appropriate boxes/ Fill in appropriate information as required/ requested and N/A for not Spo2 99
    applicable Systolic BP 140
    Diastolic BP 80
    2. Notify Physician For any abnormalities noted Height
    3. Completes Form upon arrival to the Clinic Weight
    RR
    HC
    Support
    Phsycological Screening: GRBS

    Calm Violent Depressed Other : Specify:

    Chief Complaints: INJURY

    Previous Medical/Surgery History:

    Medication recconcillation(Home Medication):


    No Yes,If Yes List Down 1 2

    3 4 5

    Immunization:
    Not Applicable Completed for age Incomplete: Specify:

    Assesment Done By :-BRAYOLJIN Date And Time :-14/12/2023 01:08 PM

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