Vital signs: T [text size="4"] F, HR [text size="4"] bpm, RR [text size="4"], BP [text size="7"], SpO2 [text size="2"]% [select value="RA|2LNC|"]
Resident is admitted to facility with diagnoses: [text size="50"]. Medication adherence has been [checkbox value="Good|Fair|Poor|Questionable|Not taking medications as prescribed|Taking more than prescribed"] [text size="50"]. [checkbox value="Allergies include |No known allergies"][text size="50"]. Resident is [checkbox value="Calm and cooperative|Irritable|Oppositional|Oriented and ambulatory|Disorganized|Responding to internal stimuli|Required significant support following direction|Sedated|Unsteady on feet|Unable to participate in admission process"].[checkbox value="Fall precautions initiated|Staff notified of contact precautions|Message left with infection control| Plan to monitor patient for safety, encourage patient to accept scheduled medications"]. Resident is [select value="awake and alert|sleeping|"] [checkbox value="oriented x|with forgetfulness|confused|no c/o pain|c/o pain (include assessment)|regular respiration even and unlabored, lungs clear to auscultation, no coughing, denies SOB or chest pain|heart sounds regular rate and rhythm|bowel sounds normoactive all quadrants, abdomen soft and nontender, Last BM ( _ )|continent of bladder, voids clear yellow urine, denies voiding difficulties, denies frequency or urgency, no flank pain|moves extremities without difficulties"] [checkbox value="Plan to "][checkbox value="Maintain contact precautions|Maintain fall precautions|adjusting well to roommate, staff, environment|call light within reach|kept clean and comfortable|"].


[text name="SHIFT" default="0700-1930"]

[textarea name="variable_1" default="MALE TEXT AREA"]

[date name="variable_1" default="05/19/2019"]
[text name="variable_2" default="sample text"] is a [checkbox name="variable_1" value="year old|male|female"]
admitted on ---[date name="variable_1" default="07/28/2019"]
diagnosed with [text name="variable_3" default="sample text"]. He is on [checkbox name="variable_4" value="regular diet|diabetic/ consistent carb diet|mechanical soft diet|finger foods| nut-free|lactose free"] with [checkbox name="variable_5" value="no known food and drug allergy|no known food allergy| ALLERGIC TO|NO known drug allergy"]
He is on
[checkbox name="variable_1" value="Q5|1:1|Q15|Q30|red risk|1:1 when using the bathroom|1:1 when eating||due to"] for level of safety, per MD orders.
[checkbox name="variable_3" value="He/She is on court cont until|He/She is under petition court date| PATIENT L2K was certified on DATE TIME"]
0730
[checkbox name="Received" value="in his room|in her room |in the courtyard|in the dayroom|getting Vitals signs taken|watching TV|laying down|respirations regular and unlabored|no apparent distress|pacing|interacting with peers|interacting with staff"]
0830
[checkbox name="variable_1" value="NO AM Meds|Compliant with AM meds|Refused |Non-compliant with AM meds|First dose ----given|Consent signed|verified consent signed|NO PRN's requested|No s/s of adverse reaction noted this shift"]


Denies[checkbox name="variable_9" value="Suicidal Ideation| Homicidal Ideation| Auditory Hallucinations| Tactile hallucination |Visual hallucinations|"]

Reports[checkbox name="variable_10" value="Suicidal Ideation| Homicidal Ideation| Auditory Hallucinations| Tactile hallucination |Visual hallucinations| Reports One bowel movement today|Reports last bowel movement on DATE "]


1400
[checkbox name="variable_1" value="option A|option B|option C|option B|option|option B|option|option B|option"]
1630
[checkbox name="variable_1" value="option A|option B|option C|option B|option|option B|option"]
1730
[checkbox name="variable_1" value="option A|option B|option C|option B|option|option B|option"]

1800
[checkbox name="variable_1" value="in his room|in her room |in the courtyard|in the dayroom|getting Vitals signs taken|watching TV|laying down|respirations regular and unlabored|no apparent distress|pacing|interacting with peers|interacting with staff"]


PATIENT IS
[checkbox name="variable_6" value="calm|cooperative|AOX4|AOX3|visible|cooperative with unit policies |interactive with peers and staff |interactive with select peers and staff| keep to self| interactive with peers and staff |poor boundaries| needs prompting| interactive with peers and staff |redirectable|attended groups|able to follow commands|pacing|interactive with peers and staff |"]
Patient appears
[checkbox name="variable_1" value="fair grooming and hygiene|poor grooming and hygiene|malodorous|non-malodorous|disheveled|steady gait|unsteady gait|poor eye contact|maintains good eye contact|blunted|bright affect|intense look|irritable|agitated|unable to focus|OPTION"]








FIRST DOSE
[checkbox name="variable_1" value="Compliant with |option B|option C|option B|option|option B|option|option B|option|option B|option"]
PRNs
[checkbox name="variable_1" value="option A|option B|option C|option B|option|option B|option|option B|option"]

[radio name="variable_1" value="Suicidal Ideation|Homicidal Ideation|Auditory Hallucinations"]

[checklist name="variable_1" value="POOR HYGIENE|option B|option C"]

Had [select name="variable_1" value=" No bowel movement|1 bowel movement|choice C"] this shift

[remark]CLEAR SPEECH[/remark]

[comment memo="COMMENT"]

[mark memo="STEADY GAIT" mark="mark"]

[var name="WHAT IS A VARIABLE"]