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Inova Fairfax Hospital for Children - Resident Sign-Out Sheet

Resident:
Pager#: 123456		 Medical Student:
Pager:		 Team:
 Date: 06/02/2004
ttest Patient99  

hecklist

Name
Mr#
Attending - DOA
DOB (age)
Room/Wt 		Active Problems / Chronic Dx Latest Labs / Tests Diet Fluids O2

Current Meds

Plan

To-Do Checklist

Prudius, Valentin
8017742
Louis-jacques-05/15
08/16/1989 (15y)
521 / 55kg
Allergies:  NKDA
Consults: Surgery;
[Edit]  [Discharge]


CLOSE
MONITORING

 ProblemList:
GI bleed -- resolved

Large portal vein -- at risk for portal vein thrombosis

Chronic Dx:
s/p multiple gunshot wounds 6/03

SMA-SMV Fistula coiled 5/17 & 5/21

[Edit]  		 3 Clears/TPN

TPN

RA
[Edit]  

Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
 Flagyl 400mg IV q6
Protonix 40mg IV BID
 Tylenol 625 mg pr q4 prn pain
[Edit]  

(NOTE TO VALENTINE: lets not change the color of the background when close monitoring is needed. Instead make a notation under patient column and add "CLOSE MONITORING" to the checklist)

treat pnuemonia.
wean O2.
rehydrate.
[Edit]  
D/C late afternoon possibly. Call attending Dr Chadive at 703 921 0256

Protonix 40mg IV BID

Morphine 4 mg IV q2-4 prn pain

Ampicillin 1gm IV q4
[Edit]  

(NOTE TO VALENTINE: If possible, format bulleted text in tables as shown above)

Fasano, AJ
8017742
Louis-jacques-05/15
08/16/1989 (15y)
521 / 55kg
Allergies:  NKDA
Consults: Surgery;
[Edit]  [Discharge] 		ProblemList:
GI bleed -- resolved
Large portal vein -- at risk for portal vein thrombosis

Chronic Dx:
s/p multiple gunshot wounds 6/03
SMA-SMV Fistula coiled 5/17 & 5/21
[Edit]  		 3 Clears/TPN

TPN

RA
[Edit]   		Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
 Flagyl 400mg IV q6
Protonix 40mg IV BID
 Tylenol 625 mg pr q4 prn pain
[Edit]   		treat pnuemonia.
wean O2.
rehydrate.
[Edit]   		Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
 Flagyl 400mg IV q6
Protonix 40mg IV BID
 Tylenol 625 mg pr q4 prn pain
[Edit]  
Pashai, Afshin
8017742
Louis-jacques-05/15
08/16/1989 (15y)
521 / 55kg
Allergies:  NKDA
Consults: Surgery;
[Edit]  [Discharge] 		ProblemList:
GI bleed -- resolved
Large portal vein -- at risk for portal vein thrombosis

Chronic Dx:
s/p multiple gunshot wounds 6/03
SMA-SMV Fistula coiled 5/17 & 5/21
[Edit]  		 33 Clears/TPN

TPN

RA
[Edit]   		Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
 Flagyl 400mg IV q6
Protonix 40mg IV BID
 Tylenol 625 mg pr q4 prn pain
[Edit]   		treat pnuemonia.
wean O2.
rehydrate.
[Edit]     		Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
 Flagyl 400mg IV q6
Protonix 40mg IV BID
 Tylenol 625 mg pr q4 prn pain
[Edit]  
Gong, Mike
8017742
Louis-jacques-05/15
08/16/1989 (15y)
521 / 55kg
Allergies:  NKDA
Consults: Surgery;
[Edit]  [Discharge] 		ProblemList:
GI bleed -- resolved
Large portal vein -- at risk for portal vein thrombosis

Chronic Dx:
s/p multiple gunshot wounds 6/03
SMA-SMV Fistula coiled 5/17 & 5/21
[Edit]  		 3 Clears/TPN

TPN

RA
[Edit]   		Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
 Flagyl 400mg IV q6
Protonix 40mg IV BID
 Tylenol 625 mg pr q4 prn pain
[Edit]   		treat pnuemonia.
wean O2.
rehydrate.
[Edit]   		Morphine 4 mg IV q2-4 prn pain
Ampicillin 1gm IV q4
Gentamycin 110mg IV q8
Flagyl 400mg IV q6
Protonix 40mg IV BID
Tylenol 625 mg pr q4 prn pain
[Edit]