LIP Restraint Note

Patient placed in [checkbox value="escort|moab|child hold|then directly into moab"] due to [checkbox value="aggressive behavior|self-harm|property destruction with the potential to result in injury to self or others|attempt to elope|need for administration of medications"][text memo="free text option" size="20"] from [text memo="time in" size="8"] to [text memo="time out" size="8"].  Report occurred with RN [checkbox value="in person |over the phone "][checkbox value="during the restraint|after the restraint"] at [text memo="time of report" size="8"]. [checkbox value="Patient examined in person within 30 minutes of the restraint.  "][checkbox value="Patient calmed without medication intervention.  |Patient received scheduled medications.  |Patient received PRN medications.  "][checkbox value="Per psychiatric emergency patient received "][checkbox value="oral medications.  |IM medications.  "][checkbox value="Patient is free of injury following restraint.  |Patient sustained injury to the "][text memo="location of injury if applicable" size="20"][checkbox value=" as a result of the restraint| as a result of the aggressive behavior| as a result of the self-injurious behavior|which was examined by this LIP|which was examined by nursing staff|which was examined by FNP|and does not require medical attention. |and required medical attention. "][checkbox value="There were no reported injuries to staff leading up to or in the process of the restraint. |Injuries to staff occurred in the nature of "][text memo="Injury to staff if applicable" size="20"] The patient is now [checkbox value="resting in their room quietly.|taking space in their room away from the milieu.|engaging in sensory activities.|reengaged safely in the milieu.|isolated from the milieu due to continued safety risk."][checkbox value=" The patient continues to struggle with emotional reactivity and poor frustration tolerance. "] [textarea memo="additional information if applicable" cols="50" rows="3"]
[text memo="LIP name" size="15"]
Patient placed in due to free text option from time in to time out. Report occurred with RN at time of report. location of injury if applicable Injury to staff if applicable The patient is now
additional information if applicable
LIP name

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Sandbox Metrics: Structured Data Index 0.62, 21 form elements, 16 boilerplate words, 7 text boxes, 1 text areas, 13 checkboxes, 46 total clicks
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