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CPRS Forms

This document provides a checklist of documents required in an inpatient file. It lists the name of the document, type of form used, and the form number where applicable. The checklist includes documents from various departments like front office, physician, nursing, dietician, rehabilitation, OT/anesthesia, billing, quality and miscellaneous. Some key documents listed are registration form, admission protocol, informed consent, physician assessment notes, nursing care plan, investigation reports, dietary assessment, physiotherapy assessment, anesthesia records, discharge summary.

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Natasha Bhasin
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198 views1 page

CPRS Forms

This document provides a checklist of documents required in an inpatient file. It lists the name of the document, type of form used, and the form number where applicable. The checklist includes documents from various departments like front office, physician, nursing, dietician, rehabilitation, OT/anesthesia, billing, quality and miscellaneous. Some key documents listed are registration form, admission protocol, informed consent, physician assessment notes, nursing care plan, investigation reports, dietary assessment, physiotherapy assessment, anesthesia records, discharge summary.

Uploaded by

Natasha Bhasin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Inpatient File Checklist

Type of
S.No Name Of Document Name of Amrita Form
Form

A Front Office
1 Registration Form FO-REGN-001
2 Face Sheet
3 Admission Protocol (Admission Advice /General Informed Consent/Estimate Form) FO-IPAD-026 Consent for Admission
FO-GENL-027,054,057,091, FO-NEPH-012, FO-NUCM-015,018, FO-ONCO-001, FO-
4 All type of Informed Consent
TRAN-011
B Physician's Assessment & Treatment notes
1 Emergency Assessment Sheet FO-EMER-003 Emergency Room case record
2 Doctor's Initial Evaluation Form FO-GENL-060 History and Physical Exam - IP
3 Plan of care
4 Investigation Order Sheet
5 Physician's Drug Order cum Administration Record
FO-NURS-067 Medication Order Sheet
6 Physician's fluid cum Non Drug order Record
7 Physicians Progress Notes FO-GENL-015 Physician Progress Notes
8 Referral Consultation Form
9 Family Counselling Form FO-NURS-141 Family Education & Counselling record
C Nursing Record
1 Nursing Admission Protocol FO-NURS-033 Dept. of Nursing - Admission Form
FO-NURS-069 Nursing Care Plan, FO-NURS-070 Additional sheet of Nursing Care
2 Nursing Care Plan
Plan
3 Nurses Notes
4 Nursing Hnadover Form FO-NURS-090 PATIENT Handover sheet for nurses
5 Vital signs chart FO-GENL-018 Vital Signs
6 Intake Output Chart FO-GENL-011 Intake Output Chart
7 Investigation Report Sheet FO-GENL-010 Investigation Sheet
8 Diabetic Chart FO-GENL-005 Blood Glucose Monitiring Chart
9 ICU Chart/CABG Chart (For all ICU Patients) FO-GENL-004 Critical Care Chart
10 Neurological Chart ( If Required)
12 Braden scale for predicting pressure ulcer( If Required)
13 Transfer Form
D Dietician's Notes
Nutrition Assessment / Reassessment Form (all categories of patient)
1 FO-DIET-048 Nutritional Assessment form
2 Diet Requisition Slip
3 Enteral Feeding Form
E Rehabilitation Notes
1 Physiotherapy/Speech/Occupational Therapy Assessment sheet (If Required) FO-REHB-001 Physical Medicine and Rehabilitation record
2 Progress Notes( If Required)
F OT / Anaesthesia records
1 Pre -op checklist FO-GENL-016 Peri operative record
2 Pre - Operative Evaluation Questionnaire
3 Anaesthesia Record FO-ANAE-001 Anesthesia Case Record
Operation/Procedure Notes -ICU, OT, CATH Lab, Recovery Room, Endoscopy,
4
Bronchoscopy, Sleep Study, DSA
5 Post Op Order
6 Surgical Safety Checklist
G Billing Records
1 Activity Track Sheet
H Quality Records
1 Incident Reporting Form
I Miscellaneous
1 Discharge Summary
2 MLC Discharge Summary/Death Summary/LAMA

FMT/NUR/132/06.08.13/0.2 Page 1 of 1

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