Redoble Medical Clinic Case No
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REDOBLE MEDICAL CLINIC
CASE NO._____________________
BUUG ZAMBOANGA SIBUGAY
DATE:___________TIME:________ PATIENT CLINICAL RECORDS
Name:__________________________________________________ Age:____ Sex:____ Status:______________ Address: ____________________________________________________ Occupation: _____________________
Temperature: ________ Blood Pressure:_______ _______________________________________ Printed name and Signature of attending Nurse 1. Admitting impression: 2. Chief complaint: 3. Reason for admission: 4. History of present illness:
5. Physical examination ( Pertinent findings only) 6. Pertinent lab. Diagnosis findings: 7. Surgical operation 8. Anesthesis & Anesthesiologist: 9. Discharge: A. Data: __________________________ Time: ________ B. Final Diagnosis:________________________________ C. Condition of discharge: __________________________ D. Signature of attending Physician: __________________ _____________________________ Signature of Patient
CASE NO._____________________
BUUG ZAMBOANGA SIBUGAY
DATE:___________TIME:________ PATIENT CLINICAL RECORDS
Name:__________________________________________________ Age:____ Sex:____ Status:______________ Address: ____________________________________________________ Occupation: _____________________
Temperature: ________ Blood Pressure:_______ _______________________________________ Printed name and Signature of attending Nurse 1. Admitting impression: 2. Chief complaint: 3. Reason for admission: 4. History of present illness:
5. Physical examination ( Pertinent findings only) 6. Pertinent lab. Diagnosis findings: 7. Surgical operation 8. Anesthesis & Anesthesiologist: 9. Discharge: A. Data: __________________________ Time: ________ B. Final Diagnosis:________________________________ C. Condition of discharge: __________________________ D. Signature of attending Physician: __________________ _____________________________ Signature of Patient
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