Download {Assessment}{age,ethnicity/race,sex, # of hospitalizations,previous

TRANSFER NOTE TO ______________ {4B or institution name}
PMD:
{Assessment}{age,ethnicity/race,sex, # of hospitalizations,previous
diagnoses/status, reason for admission – physiologic & disease, current condition}
HPI: {copy from the HPI and modify}
PICU COURSE: Complicated/Uncomplicated, Hospital Day #
System by System
NEUROLOGY: … has normal activity for age, not in distress, interacts with medical
staff and mother
RESPIRATORY: {patient initially seen with severe respiratory distress and
significant desaturations... managements... PEFR status.... assoc symptoms... day of
discharge status
CARDIOVASCULAR: any issues, day of discharge status
FEN: Initially NPO for respiratory distress and maintained on IV fluids... any
electrolyte issues, any feeding issues, outcome... day of discharge status
GI: initially NPO, now tolerating full PO well. Admission Wt: , Current Wt:
HEMATOLOGY: initial CBC done showed {results}... progress... issues. Day of
discharge.
GU/RENAL: no issues, normal urine output... UA results, BUN.Creat results
INFECTION: remained afebrile... signs of URI and infections... treatment
undertaken... day of discharge status
PSYCHOSOCIAL: Mother is with patient involved in patient care, no insurance
problems.... Evaluated by SW, with no social issues and cleared for discharge.
OTHERS: any other pertinent issues
ASSESSMENT:
{Assessment}{age,ethnicity/race,sex, # of hospitalizations,previous
diagnoses/status, reason for admission, current condition - number problems if
necessary}
PLAN:
For transfer to {4B/Institution Name}
{list current therapies and medications}
{pending studies, reports, consults to follow}
Signed out to _______________ {name of resident} at phone no. ______________
Discussed with Attending Dr. Alvarez