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These medical forms are used to record and monitor a patient’s information, health status, and medical history. They help healthcare professionals track the patient’s condition, ensure accurate documentation, and support proper decision-making for effective patient care. Additionally, these forms help individuals who wish to avail of the services we provide.
 

Please fill out these forms as accurately as possible so we can provide the best care for your health needs. 

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Your health information is personal, and we are committed to keeping it safe. Any data you provide is collected and processed in strict accordance with the Philippine Data Privacy Act of 2012. We use your information solely to provide quality medical care and will never share it without your explicit consent, except as required by law.

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WELCOME!

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FORMS

Admission Form

Contains the patient’s basic personal information, reason for admission, and initial details upon entering the hospital. It serves as the official record that starts the patient’s hospital care.

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Documents the patient’s health history and current physical examination findings. It includes vital signs and system-based assessments to help healthcare providers evaluate the patient’s condition and guide appropriate care.

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History Record

Vital Signs
Sheet

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Used to regularly record the patient’s temperature, pulse, respiration, blood pressure, and sometimes oxygen saturation. It helps healthcare providers track changes in the patient’s condition over time.

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Graphic
Sheet

Visually presents important clinical data such as vital signs in a chart or graph form. This allows healthcare providers to easily identify trends and changes in the patient’s status.

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IV Fluid Chart

Records the type, amount, and rate of intravenous fluids administered to the patient. It helps ensure accurate monitoring and safe fluid management.

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Medication Sheet

Lists all medications prescribed to the patient, including dosage, route, and time of administration. Nurses use this sheet to ensure medications are given correctly and on schedule.

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Doctor's Order

Contains instructions from the physician regarding the patient’s treatment, medications, laboratory tests, and other procedures. Healthcare staff follow these orders to guide patient care.

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Kardex Sheet

A quick-reference summary of important patient information, including diagnosis, treatments, and nursing care instructions. It helps nurses efficiently manage and coordinate patient care during shifts.

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Nursing Care Plan

Outlines the patient’s nursing diagnoses, goals, planned interventions, and expected outcomes. It guides nurses in providing organized and individualized patient care.

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Nurses Notes

Documents the patient’s condition, nursing interventions, and responses to treatment throughout the shift. These notes provide a continuous record of the patient’s progress.

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Input and Output

Records all fluids taken in by the patient (oral or IV) and all fluids eliminated (such as urine, vomit, or drainage). It is used to monitor the patient’s fluid balance and overall health status.

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