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TRANSFER REPORT SHEET Room: Date: Time: Admit To: _________7 North _________CVICU _________Other Team: Neuro: Mobility: Weakness: Name: MRN: Attending: Outside Hospital Facility: Contact Number: Nurse Calling Report: DX/ Reason for admission to OSH: Travel Time to VUH/ ETA: Leaving OSH @: Reason for TX to VUH: Reason for ICU Bed: CV: Rhythm: Ectopy: Pulses: Edema: Pulm: RR: 02 sat /O2: Situation: History: Procedures at OSH: Meds given: Abnormal Labs: Allergies: GI: BM: Diet: NPO Fluid restriction: Blood Sugar: GU: Foley Skin/ wound: Pressure Ulcer: Infectious Disease/Isolation: IV site: Drips: Code Status/ Living will: Social/ Family: Recommendation/Plan: Pain: Temp: HR: BP: