Transcription of PHYSICIAN'S ORDER SHEET - Hospital Forms
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PHYSICIAN'S ORDER SHEET - Hospital Forms
Doctor's Signature _____,MD Date _____Nurse's Signature / Title_____ 8850049 Rev 02/06 PAGE 1 of 3 DIET: CXR PA & Lateral EKG IV Heparin Lock RESPIRATORY THERAPY: O2 therapy as indicated after ABG _____ 02 by _____ O2 saturation by oximetry on room air at admission. If less than 95%, do blood gases LABS: if not done in ER: 1. CBC c diff on DAY 1 (and) DAY 3 Severe Pneumonia Physicians Order_CLINICAL PATHWAYS_MEDICAL AFFAIRSFAXED BY/TIME: Document Pulmonary Assessment every shift VS every 4 hrs X 24 hrs; then every shift If Temp > 102 F and if Patient is uncomfortable: MEDICATIONS:Military Time > >PATIENT IDENTIFICATION DATE: TIME:ALL ORDERS WILL BE FULFILLED UNLESS CROSSED OUTPHYSICIAN'S ORDER SHEET TO PHARMACY WHETHER OR NOT ORDERS INVOLVE EACH ORDER IS PROPERLY CHECKED, FAX ORDER SHEETSEVERE / COMPLICATED P
ANTIBIOTICS - start after cultures - within 4 hrs of admission x 3 days OPTION #1 Ceftriaxone (Rocephin) 1 gram IV daily AND Azithromycin (Zithromax) 500 mg IV daily. OPTION #2 Levofloxacin (Levaquin) 750 mg IV daily. OPTION #3 Piperacillin / Tazobactam (Zosyn) 3.375 gm IV every 6 hours (for confirmed aspiration) AND Azithromycin (Zithromax) 500 mg IV daily.
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