Download CDS-11, Patient Symptoms Line Listing (Respiratory Tract Infection)

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript 
PATIENT SYMPTOMS LINE LISTING
(Respiratory Tract Infection)
E-
New Jersey Department of Health
Infectious and Zoonotic Diseases Program
1
2
3
4
5
6
7
8
9
10
CDS-11
NOV 15
Discharge Date
Admission Date
Hospitalized?
Culture Done?
Pneumococcal Vaccine Given?
CXR
(Results)
Flu Vaccine Given?
Nausea/Vomit/Diarrhea
Fatigue
Myalgia
Sore Throat
SOB/Resp. Distress
Nasal Congestion
Cough (Dry/Productive)
Max. Temp.
Age/Sex
Room/Job
Wing
Onset Date
Resident
Staff
Name
Rales/Wheeze/Rhonchi
Please check (X) those items that apply and complete requested information.
Comments
(Note: Hospital Name; Dx; other
significant clinical information;
culture results, etc.)
Related documents