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Download Pt. Sticker Type of probe used: reusable disposable # of probes
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Pt. Sticker For babies discharged from NBN Birth Date___________ Birth Time___________ 24hr. due@___________ Type of probe used: Placement â–¡reusable â–¡disposable # of probes used Initial 1st 2nd MD ECHO reading Repeat Repeat Notified Date & Time Right hand RT/LT foot yes yes yes no no no Other Orders Received [ Check all that applied ] _____CBC _____Cultures : Blood : CSF : Other culture_____________________ _____Blood Pressures X 4 _____CXR _____Oxygen Via NC, Blow By, Oxyhood, NCPAP, BMV, ETT, Ventilator _____Transfer to NICU Level 2 : NICU Level 3 _____Transfer to TCH : Other Facility ____________________________________________ Final diagnosis, if known: Please place this sheet in Transfer TxPOP for CCHD screening Collection BOX.
