Manual: Provision of Care, Treatment and Services Manual (Ver 3) External Reference: "(TJC PC.01.02.01, PC.01.02.03, PC.01.02.05)"
As the health care industry's most comprehensive library of customizable policy and procedure templates, MCN Healthcare's Provision of Care, Treatment and Services Manual includes this customizable template, Admission Assessment Form. MCN's policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more. Health care organizations around the world utilize MCN's compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards. Here is some sample content from Admission Assessment Form:
| | ADMISSION ASSESSMENT
Patient Name:
Admission Date:
Vital Statistics
Height:
Pulse:
Diagnosis admitting and any secondary diagnoses or co-morbidities:
Patient's Concept of Reason for Hospitalization:
Patient States/Exhibits Presence of Pain:
Non-Verbal Patient Exhibiting Symptom of Pain:
Comprehensive Pain Assessment to be completed as addendum for all patients in whom pain has been identified
Current Medication: Home List
see also Medication Reconciliation/Verification FormOTC Medication:Name
For additional medications, attach Supplemental Current Medication ListFrom Home
Pharmacy
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Physical Therapy Comments:
10.
No problemsMenses: Regular Irregular Heavy flow Bleeding between periods Pap smear within a year? Lumps in breast Pregnant # of months Delivery within past 12 months LactatingVaginal discharge: White Green Other:
Comments:
11.
Description - Color: Normal Ashen Cyanotic Jaundice PaleMoisture: Dry MoistTemperature: Warm Cool Cold Good turgor Poor turgorSkin Integrity Intact: Yes No Pruritus Rashed Pressure ulcers Swelling Bruising Scars Other:... |
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