322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
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HILO MEDICAL CENTER<strong>EMERGENCY</strong> <strong>DEPARTMENT</strong> ENCOUNTER <strong>FORM</strong>Point Based Emergency Acuity Level Charging GuidePatient Name:________________________________________________________Date of Service: ______________________________________________________Admitted: _____________ Discharge: _____________ Transfer:______________Office Use:Nurse: ____________________________________________________ER Clerk:__________________________________________________Data Entry Clerk: __________________________________________ 11/22/06POINT VALUE 10 POINT VALUE 20 POINT VALUE 30 POINT VALUE 40 POINT VALUE 50ASSESSMENTX Triage assessmentPsych Eval (simple)Reassessment - ER staffRestraint Usage (child)Pediatric WeightCirculation Sensation &Motion (CMS) ChecksUA/Tox Screencollected by staffCulture Screen - throat -wnd - collected by staffX Med ScreeningExam/Nsg Asmt (of MSEonly, use #8900003)Neuro (CNS) ChecksAssessment - PsychNurse (BHR)Eye AcuityC - Collar/Miami J CollarApplicationCombative or DisruptivePatient/Restraint Usage(adult)Psych Eval (Complex)MD ConsultSuicide Precaution 1:1Pedi-Bag for UAPO Meds (simple)Meal Set UpTopical MedicationsSuppositoriesOrthostatic Vital SignsET MedsPO Meds (complex)Sublingual Meds - withcontinued assessmentsS/L flush / D/CMEDICATION / FLUID ADMINISTRATIONNoc Cabinet Meds -issuedCharcoal / Sorbitol AdminPortacath accessRapid Sequence IntubationArterial Line Placement(assist)1:1 Care - Trauma, Cardiac, suicideprecautions - Transfers (Queens)Thrombolytic Therapy -Cardiac 1:1 CarePacemaker Insertion (assist)Vascath - assistDeclotting (after hours)PO Meds (complex) -oral contrastCharcoal / Ipecac AdminMed List / ValuablesG-Tube FlushORTHOPEDIC CAREWalker InstructionsHip Fract. Care PathCold/Hot Pack ApplicationCrutch Use instructionsWOUND CARESteri Strip ApplicationRing RemovalWound Dressing(complex)Suture Set Up - SterileIrrigation with simpulse(complex)Wound Dressing(intermediate)Wound Prep (complex)Irrigation of WoundSuture RemovalWound Dressing (simple)Wound Prep(intermediate)Wound Prep (simple)<strong>FORM</strong> <strong>322</strong>-<strong><strong>05</strong>43</strong> Rev. 5/<strong>07</strong>
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