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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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SAM
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Whi
te P
OF
Page
PO-001 - 3-part POF/MAR Combo
A three-part carbonless laser form that combines a 2-part physician’s order form with a medication administration record.
Hand-written changes and notes made on the top white sheet transfer onto the yellow page and the medication record however they do not transfer to the charting section of the medication record.
Available in straight- and reverse-collated sequencing.
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MEDICATIONS HOUR ORDERS
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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MAR
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Canar
y PO
F Pa
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
LFPOF17
The following pages show some of the templates or formats available in FrameworkLTC for SoftWriters’ 3-part PO-001 form.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
Take One Tablet By Mouth Once
Daily
1000230RX#
Take One Tablet By Mouth Once
Daily
For:Levothyroxine Sod 1000191RX#
Hypothyroidism
Take One Tablet Every Other Day
1000202RX#
Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Happy Acres - Format # LFPOF263 on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Blood Glucose Monitoring
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
12/31/2016 12/31/2016
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
08/30/16
8 AM
12/30/16
8AM
04/22/13
8AM
04/22/13
12PM
11/24/15
12:00PM
EAST 1:10
Page 1continued
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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�����������������
���� ����
�������������� ��� ����� �������������
�����
����
MEDICATION REVIEWPHARMACIST’S SIGNATURE
������������������ ��
����
����
��� �����
�����������������
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
Take One Tablet By Mouth Once
Daily
1000230RX#
Take One Tablet By Mouth Once
Daily
For:Levothyroxine Sod 1000191RX#
Hypothyroidism
Take One Tablet Every Other Day
1000202RX#
Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
412-492-9851
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
Check Blood Pressure Daily and Notify Physician if SYS >
100 and DIA >100 Consistently.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Instill 2 Drops Each Ear Before Bed
RO#200007 02/12/14
APPLY AS DIRECTED
RO#200062 11/24/15
Happy Acres - Format # LFPOF263 on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Blood Glucose Monitoring
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
*** Diets ***
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
12/31/2016 12/31/2016
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
08/30/16
8 AM
12/30/16
8AM
04/22/13
8AM
04/22/13
12PM
11/24/15
12:00PM
EAST 1:10
Page 1continued
MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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LFPOF263
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
Take One Tablet By Mouth Once
Daily
1000230RX#
Take One Tablet By Mouth Once
Daily
For:Levothyroxine Sod 1000191RX#
Hypothyroidism
Take One Tablet Every Other Day
1000202RX#
Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
412-492-9851
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
Check Blood Pressure Daily and Notify Physician if SYS >
100 and DIA >100 Consistently.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Instill 2 Drops Each Ear Before Bed
RO#200007 02/12/14
APPLY AS DIRECTED
RO#200062 11/24/15
Happy Acres - Format # LFPOF263 on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Blood Glucose Monitoring
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
*** Diets ***
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
12/31/2016 12/31/2016
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
08/30/16
8 AM
12/30/16
8AM
04/22/13
8AM
04/22/13
12PM
11/24/15
12:00PM
EAST 1:10
Page 1continued
PO-001 — Custom
3. Nurse and physician signature
4. Pharmacist's signature
1. Five hole punch top and side
2. Nine drug boxes, print order determined by format
Email [email protected] for samples and pricing.
frameworkltc.com/forms-labels 412-492-9841 [email protected]
Available in straight- and reverse-collated sequencing.
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
LFPOF17LFPOF17
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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X
X
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X
X
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X
X
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X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
LFPOF17-P LFPOF19
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30
200087RO#
8 AM FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRES108 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30
200087RO#
8 AM FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRES108 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Page 1
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30
200087RO#
8 AM
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRES108 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
Page 1
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INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet Every Other Day
1000202RX#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Take One Tablet By Mouth Once
Daily.
1000269RX#
12PM
12:00p
8 AM
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
04/22/13
11/24/15
08/30/16
06/06/19
(Continued on next page)
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet Every Other Day
1000202RX#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Take One Tablet By Mouth Once
Daily.
1000269RX#
12PM
12:00p
8 AM
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
04/22/13
11/24/15
08/30/16
06/06/19
(Continued on next page)
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF30LFPOF29
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet Every Other Day
1000202RX#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Take One Tablet By Mouth Once
Daily.
1000269RX#
12PM
12:00p
8 AM
4 pm
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
04/22/13
11/24/15
08/30/16
06/06/19
(Continued on next page)
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1 CNTD
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF30
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1 CNTD
LFPOF30
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1 CNTD
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MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
Take One Tablet By Mouth Once
Daily
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.
M. once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/2020 10/30/2020Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/2016
Williams,Rita M. F 07/08/1932 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
LFPOF31 LFPOF31
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
Take One Tablet By Mouth Once
Daily
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.
M. once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/2020 10/30/2020Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/2016
Williams,Rita M. F 07/08/1932 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
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MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
Take One Tablet By Mouth Once
Daily
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
Happy Acres
09/30/2020 10/30/2020Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/2016
Williams,Rita M. F 07/08/1932 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Page 1
30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - Format # LFPOF44 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - Format # LFPOF44 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
Happy Acres - Format # LFPOF44 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10LFPOF44 LFPOF44
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Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF44-NX for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF44-NX for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF44-NX LFPOF44-P
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
Happy Acres - LFPOF44-NX for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF44-P for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF44-P LFPOF44-P
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF44-P for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
Happy Acres - LFPOF44-P for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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MEDICATIONS HOUR ORDERS
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Start: 12/30/16
Take One Tablet Every Other Day
1000202RX#
Start: 04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Start: 11/24/15
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Start: 08/30/16
Take One Tablet By Mouth Once
Daily.
1000269RX#
Start: 06/06/19
12PM
12:00P
8 AM
4 PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
(Continued on next page)Page 1
LFPOF50 LFPOF50
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Start: 12/30/16
Take One Tablet Every Other Day
1000202RX#
Start: 04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Start: 11/24/15
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Start: 08/30/16
Take One Tablet By Mouth Once
Daily.
1000269RX#
Start: 06/06/19
12PM
12:00P
8 AM
4 PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
(Continued on next page)Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF50 LFPOF55
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Start: 12/30/16
Take One Tablet Every Other Day
1000202RX#
Start: 04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Start: 11/24/15
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Start: 08/30/16
Take One Tablet By Mouth Once
Daily.
1000269RX#
Start: 06/06/19
12PM
12:00P
8 AM
4 PM
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Side Effect
Side Effect
Side Effect
Side Effect
Sudden Death; Cerebral Edema; Atelectasis; Circulatory Shock; Asthma
Tracheobronchial Calcification; Skin Necrosis
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia
(Continued on next page)Page 1
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
For:COUMADIN
Take One Tablet By Mouth Once
Daily
200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
08/30/16
12/30/16
04/22/13
04/22/13
02/12/14
11/24/15
06/06/19
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF55 LFPOF55
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
For:COUMADIN
Take One Tablet By Mouth Once
Daily
200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
08/30/16
12/30/16
04/22/13
04/22/13
02/12/14
11/24/15
06/06/19
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
For:COUMADIN
Take One Tablet By Mouth Once
Daily
200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
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12/30/16
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04/22/13
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11/24/15
06/06/19
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MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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LFPOF55-A LFPOF55-A
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
For:COUMADIN
Take One Tablet By Mouth Once
Daily
200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
8 AM
8 PM
12PM
7PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
EAR WAX DROP SOL 6.5% OT
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
08/30/16
02/12/14
04/22/13
04/22/13
11/24/15
06/06/19
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
For:COUMADIN
Take One Tablet By Mouth Once
Daily
200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
8 AM
8 PM
12PM
7PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
EAR WAX DROP SOL 6.5% OT
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
08/30/16
02/12/14
04/22/13
04/22/13
11/24/15
06/06/19
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
Instill 2 Drops Each Ear Before
Bed
200007RO#
Take One Tablet Every Other Day
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
200006RO#
For:COUMADIN
Take One Tablet By Mouth Once
Daily
200063RO#
Take One Tablet By Mouth Once
Daily.
200101RO#
8 AM
8 PM
12PM
7PM
12:00p
4 pm
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
EAR WAX DROP SOL 6.5% OT
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
X
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X
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X
X
X
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X
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12/30/16
08/30/16
02/12/14
04/22/13
04/22/13
11/24/15
06/06/19
LFPOF55-A LFPOF58
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 12/28/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 7004025 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF58 LFPOF58
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 12/28/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 7004025 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
200010RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
Happy Acres
09/30/20 12/28/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 7004025 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
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Page 1
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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LFPOF58-P LFPOF58-P
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 12/28/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 7004025 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 12/28/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 7004025 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
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MEDICATIONS HOUR
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF58-P LFPOF61
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
8 AM
12PM
7PM
8 PM
12:00p
4 pm
Happy Acres
09/30/20 12/28/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 7004025 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Page 1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - Format # LFPOF61 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR ORDERS
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF61 LFPOF61
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - Format # LFPOF61 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Happy Acres - Format # LFPOF61 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATION REVIEWNURSE’S SIGNATURE
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LFPOF61-NX LFPOF61-NX
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF61-NX LFPOF61-P
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Happy Acres - LFPOF61-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-P for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF61-P LFPOF61-P
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-P for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Happy Acres - LFPOF61-P for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR ORDERS
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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LFPOF61-PNX LFPOF61-PNX
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-PNX on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-PNX on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF61-PNX LFPOF61-PNXD
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Happy Acres - LFPOF61-PNX on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-PNXD for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR ORDERS
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF61-PNXD LFPOF61-PNXD
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text....
412-492-9851
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text here...
Happy Acres - LFPOF61-PNXD for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Happy Acres - LFPOF61-PNXD for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
Routine Orders
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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LFPOF75 LFPOF75
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
8 PM
12PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
EAR WAX DROP SOL 6.5% OT
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
8 PM
12PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
EAR WAX DROP SOL 6.5% OT
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
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MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF75 LFPOF80
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
8 PM
12PM
12:00p
8 AM
4 pm
7PM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
EAR WAX DROP SOL 6.5% OT
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Page 1
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF80 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF80 LFPOF80
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF80 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF80 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
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LFPOF80-NX LFPOF80-NX
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF80-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF80-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
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MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF80-NX LFPOF80-P
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF80-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF80-P for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF80-P LFPOF80-P
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF80-P for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF80-P for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
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LFPOF86 LFPOF86
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF86 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF86 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
Happy Acres - LFPOF86 for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10LFPOF86 LFPOF86-TL
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF86-TL for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF86-TL LFPOF86-TL
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF86-TL for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Use as Directed
200092RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
200093RO#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
200082RO#
REFILLS REMAINING #0
Happy Acres - LFPOF86-TL for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025
Williams,Rita M.F 07/08/32 2097 HACRESW
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
zyPREXA 7.5MG-TABS
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
05/24/18
12/30/16
06/19/18
08/30/16
8 AM
Page 1
EAST 1:10
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LFPOF101 LFPOF101
Take One Tablet By Mouth Once
Daily
1000272RX#
Start: 04/24/20
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Start: 04/12/17
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Start: 06/02/20
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Start: 07/11/18
Instill 2 Drops Each Ear Before
Bed
1000226RX#
Start: 02/12/14
Use as Directed
1000260RX#
Start: 05/24/18
Take One Tablet By Mouth Once
Daily
1000273RX#
Start: 05/07/20
10a
8 PM
8 AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Page 1(Continued on next page)
Take One Tablet By Mouth Once
Daily
1000272RX#
Start: 04/24/20
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Start: 04/12/17
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Start: 06/02/20
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Start: 07/11/18
Instill 2 Drops Each Ear Before
Bed
1000226RX#
Start: 02/12/14
Use as Directed
1000260RX#
Start: 05/24/18
Take One Tablet By Mouth Once
Daily
1000273RX#
Start: 05/07/20
10a
8 PM
8 AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Page 1(Continued on next page)
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF101 LFPOF105
Take One Tablet By Mouth Once
Daily
1000272RX#
Start: 04/24/20
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Start: 04/12/17
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Start: 06/02/20
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Start: 07/11/18
Instill 2 Drops Each Ear Before
Bed
1000226RX#
Start: 02/12/14
Use as Directed
1000260RX#
Start: 05/24/18
Take One Tablet By Mouth Once
Daily
1000273RX#
Start: 05/07/20
10a
8 PM
8 AM
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Side Effect
Side Effect
Side Effect
Side Effect
Side Effect
Side Effect
Hepatitis; Azotemia; Pancytopenia; Agranulocytosis; Renal Failure Syndrome
Drowsiness; Behavioral Problems; Upper Respiratory Tract Infection; Depres
Drowsiness; Behavioral Problems; Upper Respiratory Tract Infection; Depres
Dizziness; Headache; Asthenia; Pain; Edema; Vasodilation; Atrial Fibrillat
Severe Hypoglycemia; Infusion Site Reaction; Antibody Development; Myalgia
Syncope; Dizziness; Hypotension; Hyperkalemia; Increased Blood Urea Nitrog
Page 1(Continued on next page)
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet Every Other Day
1000202RX#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Take One Tablet By Mouth Once
Daily.
1000269RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
04/22/13
11/24/15
08/30/16
06/06/19
(Continued on next page)
12PM
12:00p
8 AM
4 pm
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF105 LFPOF105
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet Every Other Day
1000202RX#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Take One Tablet By Mouth Once
Daily.
1000269RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
04/22/13
11/24/15
08/30/16
06/06/19
(Continued on next page)
12PM
12:00p
8 AM
4 pm
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet Every Other Day
1000202RX#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
1000215RX#
Take One Tablet By Mouth Once
Daily.
1000269RX#
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
12/30/16
04/22/13
11/24/15
08/30/16
06/06/19
(Continued on next page)
12PM
12:00p
8 AM
4 pm
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF114 for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
LFPOF114 LFPOF114
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF114 for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF114 LFPOF119
Diabetic Literal Order text....
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF114 for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
6 am
Weekly
Wednes
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF119 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF119 LFPOF119
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF119 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF119 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
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LFPOF119-NX LFPOF119-NX
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF119-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - LFPOF119-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF119-NX LFPOF119-P
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF119-NX for PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - Format # LFPOF119-P for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF119-P LFPOF119-P
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text....
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Test to print on LEFT side.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text here...
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - Format # LFPOF119-P for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - Format # LFPOF119-P for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
12/30/16
05/24/18
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
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LFPOF120 LFPOF120
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
8 PM
12PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
EAR WAX DROP SOL 6.5% OT
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
Medicare No:40700351
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
8 PM
12PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
EAR WAX DROP SOL 6.5% OT
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
Medicare No:40700351
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF120 LFPOF134
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
200007RO#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
200087RO#
Take One Tablet Every Other Day
Orig:04/22/13
200004RO#
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
For:COUMADIN 200063RO#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
200082RO#
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
200101RO#
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
200006RO#
8 PM
12PM
12:00p
8 AM
4 pm
7PM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
EAR WAX DROP SOL 6.5% OT
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
X
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Page 1
Medicare No:40700351
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig: 12/30/16
Take One Tablet Every Other Day
Orig: 04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN
Orig: 11/24/15
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig: 08/30/16
Take One Tablet By Mouth Once
Daily.
Orig: 06/06/19
12PM
12:00p
8 AM
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
(Continued on next page)Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF134 LFPOF134
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig: 12/30/16
Take One Tablet Every Other Day
Orig: 04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN
Orig: 11/24/15
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig: 08/30/16
Take One Tablet By Mouth Once
Daily.
Orig: 06/06/19
12PM
12:00p
8 AM
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
(Continued on next page)Page 1
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig: 12/30/16
Take One Tablet Every Other Day
Orig: 04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN
Orig: 11/24/15
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig: 08/30/16
Take One Tablet By Mouth Once
Daily.
Orig: 06/06/19
12PM
12:00p
8 AM
4 pm
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Side Effect
Side Effect
Side Effect
Side Effect
Sudden Death; Cerebral Edema; Atelectasis; Circulatory Shock; Asthma; Cya
Tracheobronchial Calcification; Skin Necrosis; Gangrene of Skin and/or Su
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia; Drug-Induced Parkin
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia; Drug-Induced Parkin
(Continued on next page)Page 1
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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LFPOF157 LFPOF157
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
12PM
PRN
8 PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
TRIFLUOPERAZ TAB 2MG
ACETAMIN TAB 325MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
12PM
PRN
8 PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
TRIFLUOPERAZ TAB 2MG
ACETAMIN TAB 325MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF157 LFPOF161
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
12PM
PRN
8 PM
12:00p
8 AM
4 pm
7PM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
TRIFLUOPERAZ TAB 2MG
ACETAMIN TAB 325MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
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Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
200103RO#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 200108RO#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 200094RO#
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
200007RO#
REFILLS REMAINING #0
Use as Directed
200092RO#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
200104RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF16 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
6 am
Weekly
Wednesday
04/24/20
10a
06/02/20
07/11/18
02/12/14
8 PM
05/24/18
05/07/20
8 AM
12/30/16
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
200103RO#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 200108RO#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 200094RO#
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
200007RO#
REFILLS REMAINING #0
Use as Directed
200092RO#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
200104RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF16 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
6 am
Weekly
Wednesday
04/24/20
10a
06/02/20
07/11/18
02/12/14
8 PM
05/24/18
05/07/20
8 AM
12/30/16
Page 1
EAST 1:10
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
200103RO#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 200108RO#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 200094RO#
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
200007RO#
REFILLS REMAINING #0
Use as Directed
200092RO#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
200104RO#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
200087RO#
REFILLS REMAINING #0
Happy Acres - LFPOF16 for PO-001 Stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
6 am
Weekly
Wednesday
04/24/20
10a
06/02/20
07/11/18
02/12/14
8 PM
05/24/18
05/07/20
8 AM
12/30/16
Page 1
EAST 1:10
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LFPOF170 LFPOF170
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
12PM
8 PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
TRIFLUOPERAZ TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
12PM
8 PM
12:00p
8 AM
4 pm
7PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
TRIFLUOPERAZ TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF170-TLFPOF170
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
12PM
8 PM
12:00p
8 AM
4 pm
7PM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
TRIFLUOPERAZ TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
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INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
8 AM
12PM
12:00p
4 pm
7PM
8 PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
8 AM
12PM
12:00p
4 pm
7PM
8 PM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Page 1
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
8 AM
12PM
12:00p
4 pm
7PM
8 PM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
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Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
HAPPY ACRES - Format # LFPOF198 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 AM
WEEKLY
WEDNESDAY
12/30/16
05/24/18
06/19/18
08/30/16
8 AM
EAST 1:10
Page 1continued
LFPOF198LFPOF198
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
HAPPY ACRES - Format # LFPOF198 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 AM
WEEKLY
WEDNESDAY
12/30/16
05/24/18
06/19/18
08/30/16
8 AM
EAST 1:10
Page 1continued
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF201LFPOF198
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
HAPPY ACRES - Format # LFPOF198 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Diabetic Literals
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
HUMALOG INJ 100/ML
TPN-Adult-A
zyPREXA 7.5MG-TABS
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 AM
WEEKLY
WEDNESDAY
12/30/16
05/24/18
06/19/18
08/30/16
8 AM
EAST 1:10
Page 1continued
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1 CNTD
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF201LFPOF201
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1 CNTD
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Orig:08/30/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Orig:12/30/16
Take One Tablet Every Other Day
Orig:04/22/13
DX:Chronic Schizophrenia
Take One Tablet By Mouth At
Bedtime
Orig:04/22/13
Instill 2 Drops Each Ear Before
Bed
Orig:02/12/14
Dispensed For:COUMADIN
Take One Tablet By Mouth Once
Daily
Orig:11/24/15
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Orig:06/06/19
Take One Tablet By Mouth Once
Daily As Needed for Pain
Orig:04/22/13
8 AM
12PM
7PM
8 PM
12:00p
4 pm
8AM
Happy Acres
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
zyPREXA 7.5MG-TABS
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
VALIUM TAB 2MG
EAR WAX DROP SOL 6.5% OT
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
ACETAMIN TAB 325MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1 CNTD
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LFPOF206LFPOF206
Take One Tablet By Mouth Once
Daily
1000272RX#
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Use as Directed
1000260RX#
Take One Tablet By Mouth Once
Daily
1000273RX#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet By Mouth Once
Daily.
1000275RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith (412)555-9999
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
TIC-TAC TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
04/24/20
04/12/17
06/02/20
07/11/18
05/24/18
05/07/20
12/30/16
05/18/20
(Continued on next page)
10A
8 AM
8 AM
Take One Tablet By Mouth Once
Daily
1000272RX#
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Use as Directed
1000260RX#
Take One Tablet By Mouth Once
Daily
1000273RX#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet By Mouth Once
Daily.
1000275RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith (412)555-9999
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
TIC-TAC TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
04/24/20
04/12/17
06/02/20
07/11/18
05/24/18
05/07/20
12/30/16
05/18/20
(Continued on next page)
10A
8 AM
8 AM
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Take One Tablet By Mouth Once
Daily
1000272RX#
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Use as Directed
1000260RX#
Take One Tablet By Mouth Once
Daily
1000273RX#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet By Mouth Once
Daily.
1000275RX#
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith (412)555-9999
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
TIC-TAC TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Page 1
04/24/20
04/12/17
06/02/20
07/11/18
05/24/18
05/07/20
12/30/16
05/18/20
(Continued on next page)
10A
8 AM
8 AM
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Start: 12/30/16
RO# 200087
Take One Tablet Every Other Day
Start: 04/22/13
RO# 200004
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Start: 11/24/15
RO# 200063
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Start: 08/30/16
RO# 200082
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Start: 06/06/19
RO# 200101
12PM
12:00p
8 AM
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
PRESCRIPTIONS VALID FOR 90 DAYS.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
(Continued on next page)Page 1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF208LFPOF208
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Start: 12/30/16
RO# 200087
Take One Tablet Every Other Day
Start: 04/22/13
RO# 200004
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Start: 11/24/15
RO# 200063
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Start: 08/30/16
RO# 200082
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Start: 06/06/19
RO# 200101
12PM
12:00p
8 AM
4 pm
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
PRESCRIPTIONS VALID FOR 90 DAYS.
_______________________________
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
(Continued on next page)Page 1
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Start: 12/30/16
RO# 200087
Take One Tablet Every Other Day
Start: 04/22/13
RO# 200004
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Start: 11/24/15
RO# 200063
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Start: 08/30/16
RO# 200082
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
Start: 06/06/19
RO# 200101
12PM
12:00p
8 AM
4 pm
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
zyPREXA 7.5MG-TABS
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Side Effect
Side Effect
Side Effect
Side Effect
Sudden Death; Cerebral Edema; Atelectasis; Circulatory Shock; Asthma;
Tracheobronchial Calcification; Skin Necrosis; Gangrene of Skin and/or
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia; Drug-Induced
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia; Drug-Induced
(Continued on next page)Page 1
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LFPOF210LFPOF210
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 1000262RX#
REFILLS REMAINING #0
Take one tablet daily
1000263RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
HAPPY ACRES - LFPOF210 for PO-011 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
NAFCILLIN 2GM IN 100ML NSS
CLONAZEPAM TAB 1MG
HUMALOG INJ 100/ML
TPN-Adult-A
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
VITAMIN B-1 TAB 100MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
04/12/17
05/24/18
06/19/18
06/02/20
07/11/18
07/11/18
EAST 1:10
Page 1continued
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 1000262RX#
REFILLS REMAINING #0
Take one tablet daily
1000263RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
HAPPY ACRES - LFPOF210 for PO-011 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
NAFCILLIN 2GM IN 100ML NSS
CLONAZEPAM TAB 1MG
HUMALOG INJ 100/ML
TPN-Adult-A
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
VITAMIN B-1 TAB 100MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
04/12/17
05/24/18
06/19/18
06/02/20
07/11/18
07/11/18
EAST 1:10
Page 1continued
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF214-SDLFPOF210
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 1000262RX#
REFILLS REMAINING #0
Take one tablet daily
1000263RX#
REFILLS REMAINING #0
HAPPY ACRES - LFPOF210 for PO-011 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
NAFCILLIN 2GM IN 100ML NSS
CLONAZEPAM TAB 1MG
HUMALOG INJ 100/ML
TPN-Adult-A
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
VITAMIN B-1 TAB 100MG
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
04/12/17
05/24/18
06/19/18
06/02/20
07/11/18
07/11/18
EAST 1:10
Page 1continued
Take One Tablet By Mouth Once
Daily
1000272RX#
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Use as Directed
1000260RX#
Take One Tablet By Mouth Once
Daily
1000273RX#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet By Mouth Once
Daily.
1000275RX#
10A
8 AM
8 AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
TIC-TAC TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
04/24/20
04/12/17
06/02/20
07/11/18
05/24/18
05/07/20
12/30/16
05/18/20
(Continued on next page)Page 1
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF214-SDLFPOF214-SD
Take One Tablet By Mouth Once
Daily
1000272RX#
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Use as Directed
1000260RX#
Take One Tablet By Mouth Once
Daily
1000273RX#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet By Mouth Once
Daily.
1000275RX#
10A
8 AM
8 AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
Prescriptions valid for 90 days.
_______________________________
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
TIC-TAC TABS
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
04/24/20
04/12/17
06/02/20
07/11/18
05/24/18
05/07/20
12/30/16
05/18/20
(Continued on next page)Page 1
Take One Tablet By Mouth Once
Daily
1000272RX#
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Use as Directed
1000260RX#
Take One Tablet By Mouth Once
Daily
1000273RX#
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet By Mouth Once
Daily.
1000275RX#
10A
8 AM
8 AM
HAPPY ACRES - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
NAFCILLIN 2GM IN 100ML NSS
TIC-TAC TABS
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic
Schizophrenia; Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
04/24/20
04/12/17
06/02/20
07/11/18
05/24/18
05/07/20
12/30/16
05/18/20
Hepatitis; Azotemia; Pancytopenia; Agranulocytosis
Drowsiness; Behavioral Problems; Upper Respiratory Tract Infection
Drowsiness; Behavioral Problems; Upper Respiratory Tract Infection
Dizziness; Headache; Asthenia; Pain; Edema; Vasodilation
Severe Hypoglycemia; Infusion Site Reaction; Antibody Development
Syncope; Dizziness; Hypotension; Hyperkalemia
(Continued on next page)Page 1
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MEDICATIONS HOUR ORDERS
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Start: 12/29/16
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Start: 12/29/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Start: 12/30/16
RO# 200087
Take One Tablet By Mouth Once
Daily
Start: 12/30/16
RO# 200086
Generic:Levothyroxine Sodium Tab
Take One Tablet By Mouth Once
Daily
Start: 04/22/13
RO# 200003
DX:Hypothyroidism
Take One Tablet Every Other Day
Start: 04/22/13
RO# 200004
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Start: 11/24/15
RO# 200063
8AM
8AM
12PM
12:00p
Instill 2 Drops Each Ear Before Bed
Orig:02/12/14
APPLY AS DIRECTED
Orig:11/24/15
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
412-492-9851
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
Check Blood Pressure Daily and Notify Physician if SYS >
100 and DIA >100 Consistently.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - Routine Meds
12/31/16 12/31/16Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
*** Diets ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
LFPOF231
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Start: 12/29/16
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Start: 12/29/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Start: 12/30/16
RO# 200087
Take One Tablet By Mouth Once
Daily
Start: 12/30/16
RO# 200086
Generic:Levothyroxine Sodium Tab
Take One Tablet By Mouth Once
Daily
Start: 04/22/13
RO# 200003
DX:Hypothyroidism
Take One Tablet Every Other Day
Start: 04/22/13
RO# 200004
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Start: 11/24/15
RO# 200063
8AM
8AM
12PM
12:00p
Instill 2 Drops Each Ear Before Bed
Orig:02/12/14
APPLY AS DIRECTED
Orig:11/24/15
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
412-492-9851
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
Check Blood Pressure Daily and Notify Physician if SYS >
100 and DIA >100 Consistently.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres - Routine Meds
12/31/16 12/31/16Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
*** Diets ***
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
LFPOF231
MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF231
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Start: 12/29/16
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Start: 12/29/16
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Start: 12/30/16
RO# 200087
Take One Tablet By Mouth Once
Daily
Start: 12/30/16
RO# 200086
Generic:Levothyroxine Sodium Tab
Take One Tablet By Mouth Once
Daily
Start: 04/22/13
RO# 200003
DX:Hypothyroidism
Take One Tablet Every Other Day
Start: 04/22/13
RO# 200004
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Start: 11/24/15
RO# 200063
8AM
8AM
12PM
12:00p
Happy Acres - Routine Meds
12/31/16 12/31/16Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
NAFCILLIN 2GM IN 100ML NSS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Side Effect
Side Effect
Side Effect
Side Effect
Pharyngitis; Uremia; Infection; Pain; Viral Infection; Dizziness;
Seizure; Coma; Angina Pectoris; Myocardial Infarction; Angioedema; Acute
Sudden Death; Cerebral Edema; Atelectasis; Circulatory Shock; Asthma;
Tracheobronchial Calcification; Skin Necrosis; Gangrene of Skin or Other
Page 1(Continued on next page)
LFPOF240
6 am
Weekly
Wednes
10a
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres
09/30/20 10/29/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
Diabetic Literals
Blood Pressure Check
Diets
IVs
Coumadin Orders
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Benzodiazepines: Haldol: Penicillins: Fibrates: Allergic to bee and wasp stings
Page 1ROUTINE MEDICATIONS
Acute Schizophrenia: Hypothyroidism: Gastroesophageal Reflux Disease: Chronic
Schizophrenia: Body Pain: Congenital Hypothyroidism: Digestive System Signs and Symptoms
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Regular 1200 cal with 100gm
added fiber.
Regular, no added salt.
IV Literal text + Custom
Instructions
Coumadin literal order text -
instructions...
Take One Tablet By Mouth Once
Daily
Rx#:1000272 Ro#:200103 04/24/20
REFILLS REMAINING #0
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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6 am
Weekly
Wednes
10a
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres
09/30/20 10/29/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
Diabetic Literals
Blood Pressure Check
Diets
IVs
Coumadin Orders
ACETAMIN TAB 325MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
Benzodiazepines: Haldol: Penicillins: Fibrates: Allergic to bee and wasp stings
Page 1ROUTINE MEDICATIONS
Acute Schizophrenia: Hypothyroidism: Gastroesophageal Reflux Disease: Chronic
Schizophrenia: Body Pain: Congenital Hypothyroidism: Digestive System Signs and Symptoms
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Regular 1200 cal with 100gm
added fiber.
Regular, no added salt.
IV Literal text + Custom
Instructions
Coumadin literal order text -
instructions...
Take One Tablet By Mouth Once
Daily
Rx#:1000272 Ro#:200103 04/24/20
REFILLS REMAINING #0
6 am
Weekly
Wednes
10a
Happy Acres
09/30/20 10/29/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
Diabetic Literals
Blood Pressure Check
Diets
IVs
Coumadin Orders
ACETAMIN TAB 325MG
Benzodiazepines: Haldol: Penicillins: Fibrates: Allergic to bee and wasp stings
Page 1ROUTINE MEDICATIONS
Acute Schizophrenia: Hypothyroidism: Gastroesophageal Reflux Disease: Chronic
Schizophrenia: Body Pain: Congenital Hypothyroidism: Digestive System Signs and Symptoms
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Regular 1200 cal with 100gm
added fiber.
Regular, no added salt.
IV Literal text + Custom
Instructions
Coumadin literal order text -
instructions...
Take One Tablet By Mouth Once
Daily
Rx#:1000272 Ro#:200103 04/24/20
REFILLS REMAINING #0
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Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF242 for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
05/24/18
12/30/16
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF242 for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
05/24/18
12/30/16
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF242 LFPOF247-3
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Happy Acres - LFPOF242 for PO-001
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
zyPREXA 7.5MG-TABS
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
08/30/16
8 AM
05/24/18
12/30/16
06/19/18
EAST 1:10
Page 1continued
Medicare No:40700351 Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
12/30/16
08/30/16
8 AM
04/22/13
12PM
11/24/15
12:00p
06/06/19
4 pm
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Take One Tablet Every Other Day
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
PRESCRIPTIONS VALID FOR 90 DAYS.
_______________________________
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
12/30/16
08/30/16
8 AM
04/22/13
12PM
11/24/15
12:00p
06/06/19
4 pm
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Take One Tablet Every Other Day
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose levels
2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep at
bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Coumadin literal order text - instructions...
Prescriptions valid for 90 days.
_______________________________
PRESCRIPTIONS VALID FOR 90 DAYS.
_______________________________
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Happy Acres - Routine Meds
09/30/20 09/30/20Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
12/30/16
08/30/16
8 AM
04/22/13
12PM
11/24/15
12:00p
06/06/19
4 pm
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
Take One Tablet Every Other Day
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
Generic:Olanzapine Tab 7.5 MG
Take One Tablet By Mouth Once
Daily.
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
zyPREXA 7.5MG-TABS
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia;
Sudden Death; Cerebral Edema; Atelectasis; Circulatory
Tracheobronchial Calcification; Skin Necrosis; Gangrene of
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia;
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Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 1000262RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take one tablet daily
1000263RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
1000273RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily.
For: 1000275RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
HAPPY ACRES - Format LFPOF254 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
VITAMIN B-1 TAB 100MG
LISINOPRIL TAB 10MG
TIC-TAC TABS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
06/02/20
07/11/18
05/24/18
12/30/16
06/19/18
07/11/18
05/07/20
8 AM
05/18/20
8 AM
EAST 1:10
Page 1continued
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 1000262RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take one tablet daily
1000263RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
1000273RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily.
For: 1000275RX#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
HAPPY ACRES - Format LFPOF254 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
VITAMIN B-1 TAB 100MG
LISINOPRIL TAB 10MG
TIC-TAC TABS
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
06/02/20
07/11/18
05/24/18
12/30/16
06/19/18
07/11/18
05/07/20
8 AM
05/18/20
8 AM
EAST 1:10
Page 1continued
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF254
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
REFILLS REMAINING #0
Take one tablet daily
For:CARDIZEM CD 1000262RX#
REFILLS REMAINING #0
Use as Directed
For:Insulin Lispro So 1000260RX#
REFILLS REMAINING #0
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
REFILLS REMAINING #0
50ml IV per hour, on 12 hours,
off 12 hours; Remove from
refrigerator 1 hour before
infusion.
1000261RX#
REFILLS REMAINING #0
Take one tablet daily
1000263RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
1000273RX#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily.
For: 1000275RX#
REFILLS REMAINING #0
HAPPY ACRES - Format LFPOF254 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
NAFCILLIN 2GM IN 100ML NSS
TPN-Adult-A
VITAMIN B-1 TAB 100MG
LISINOPRIL TAB 10MG
TIC-TAC TABS
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
06/02/20
07/11/18
05/24/18
12/30/16
06/19/18
07/11/18
05/07/20
8 AM
05/18/20
8 AM
EAST 1:10
Page 1continued
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
Take One Tablet By Mouth Once
Daily
1000230RX#
Take One Tablet By Mouth Once
Daily
For:Levothyroxine Sod 1000191RX#
Hypothyroidism
Take One Tablet Every Other Day
1000202RX#
Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
412-492-9851
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
Check Blood Pressure Daily and Notify Physician if SYS >
100 and DIA >100 Consistently.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Instill 2 Drops Each Ear Before Bed
RO#200007 02/12/14
APPLY AS DIRECTED
RO#200062 11/24/15
Happy Acres - Format # LFPOF263 on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Blood Glucose Monitoring
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
*** Diets ***
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
12/31/2016 12/31/2016
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
08/30/16
8 AM
12/30/16
8AM
04/22/13
8AM
04/22/13
12PM
11/24/15
12:00PM
EAST 1:10
Page 1continued
LFPOF263
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF263
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
Take One Tablet By Mouth Once
Daily
1000230RX#
Take One Tablet By Mouth Once
Daily
For:Levothyroxine Sod 1000191RX#
Hypothyroidism
Take One Tablet Every Other Day
1000202RX#
Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
412-492-9851
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
Check Blood Pressure Daily and Notify Physician if SYS >
100 and DIA >100 Consistently.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Instill 2 Drops Each Ear Before Bed
RO#200007 02/12/14
APPLY AS DIRECTED
RO#200062 11/24/15
Happy Acres - Format # LFPOF263 on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Blood Glucose Monitoring
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
*** Diets ***
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
12/31/2016 12/31/2016
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
08/30/16
8 AM
12/30/16
8AM
04/22/13
8AM
04/22/13
12PM
11/24/15
12:00PM
EAST 1:10
Page 1continued
Use test strips (AccuCheck) to
check blood glucose levels 2
TIMES A DAY.
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
1000231RX#
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
For:Olanzapine Tab 7. 1000215RX#
Take One Tablet By Mouth Once
Daily
1000230RX#
Take One Tablet By Mouth Once
Daily
For:Levothyroxine Sod 1000191RX#
Hypothyroidism
Take One Tablet Every Other Day
1000202RX#
Chronic Schizophrenia
Take One Tablet By Mouth Once
Daily
For:COUMADIN 1000151RX#
Happy Acres - Format # LFPOF263 on PO-001 Stock
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 HACRESW
Blood Glucose Monitoring
Blood Pressure Check
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
PARICALCITOL CAP 1 MCG
SYNTHROID TAB 125MCG
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
12/31/2016 12/31/2016
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
12/30/16
08/30/16
8 AM
12/30/16
8AM
04/22/13
8AM
04/22/13
12PM
11/24/15
12:00PM
EAST 1:10
Page 1continued
LFPOF263
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LFPOF301 LFPOF301
Take One Tablet By Mouth Once
Daily
1000272RX#
Start: 04/24/20
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Start: 04/12/17
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Start: 06/02/20
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Start: 07/11/18
Instill 2 Drops Each Ear Before
Bed
1000226RX#
Start: 02/12/14
Use as Directed
1000260RX#
Start: 05/24/18
Take One Tablet By Mouth Once
Daily
1000273RX#
Start: 05/07/20
10a
8 PM
8 AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Page 1(Continued on next page)
Take One Tablet By Mouth Once
Daily
1000272RX#
Start: 04/24/20
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Start: 04/12/17
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Start: 06/02/20
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Start: 07/11/18
Instill 2 Drops Each Ear Before
Bed
1000226RX#
Start: 02/12/14
Use as Directed
1000260RX#
Start: 05/24/18
Take One Tablet By Mouth Once
Daily
1000273RX#
Start: 05/07/20
10a
8 PM
8 AM
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Diabetic Literal Order text + instructions
412-492-9851
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
IV Literal text + Custom Instructions
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Ancillary Orders ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** IVs ***
*** Diets ***
*** Coumadin Orders ***
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Page 1(Continued on next page)
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF301
Take One Tablet By Mouth Once
Daily
1000272RX#
Start: 04/24/20
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
For:KLONOPIN 1000250RX#
Start: 04/12/17
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
For:KLONOPIN 1000280RX#
Start: 06/02/20
Take one tablet daily
For:CARDIZEM CD 1000262RX#
Start: 07/11/18
Instill 2 Drops Each Ear Before
Bed
1000226RX#
Start: 02/12/14
Use as Directed
1000260RX#
Start: 05/24/18
Take One Tablet By Mouth Once
Daily
1000273RX#
Start: 05/07/20
10a
8 PM
8 AM
Happy Acres
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:1 W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
09/30/2020 09/30/2020
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Side Effect
Side Effect
Side Effect
Side Effect
Side Effect
Side Effect
Hepatitis; Azotemia; Pancytopenia; Agranulocytosis; Renal Failure Syndrome
Drowsiness; Behavioral Problems; Upper Respiratory Tract Infection; Depres
Drowsiness; Behavioral Problems; Upper Respiratory Tract Infection; Depres
Dizziness; Headache; Asthenia; Pain; Edema; Vasodilation; Atrial Fibrillat
Severe Hypoglycemia; Infusion Site Reaction; Antibody Development; Myalgia
Syncope; Dizziness; Hypotension; Hyperkalemia; Increased Blood Urea Nitrog
Page 1(Continued on next page)
LFPOF308
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF308 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 10/29/20
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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LFPOF308 LFPOF308
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF308 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 10/29/20
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Twice
Daily. Format # TFLBL448-G for
TRX-016 Label.
Drug Like: 1000250Rx#
KLONOPIN
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Happy Acres - LFPOF308 for PO-001 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
09/30/2020 10/29/20
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
04/12/17
06/02/20
07/11/18
02/12/14
8 PM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR ORDERS
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LFPOF313 LFPOF313
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Use as Directed
1000260Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
1000273Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF313 for PO-010 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 10/29/20
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
06/02/20
07/11/18
02/12/14
8 PM
05/24/18
05/07/20
8 AM
Page 1
HACRES
POS-HACRES-2097-09/20-1
Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Use as Directed
1000260Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
1000273Rx#
REFILLS REMAINING #0
FBS Bi-Monthly
Annual PPD unless previous positve reaction as per
facility policy.
Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
FLU VACCINE (If resident not allergic) Inject 0.5ml I.M.
once a year (Oct thru March)
Diabetic Literal Order text + instructions
412-492-9851
Note if suseptible to falls.
Use test strips (AccuCheck) to check blood glucose
levels 2 TIMES A DAY.
I have reviewed and approve of the Comprehensive
Assessment, the Plan of Care, and the Discharge Plan.
Skin Breakdown Prevention measures: Pressure Reduction
Matress Pad/Daily. Dangle heels off bed with pillow.
Knee-High TED Stockings Bilaterally for Swelling
Apply EUCERIN lotion to dry skin after bath. May keep
at bedside.
Regular 1200 cal with 100gm added fiber.
Regular, no added salt.
IV Literal text + Custom Instructions
Happy Acres - LFPOF313 for PO-010 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
09/30/2020 10/29/20
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
06/02/20
07/11/18
02/12/14
8 PM
05/24/18
05/07/20
8 AM
Page 1
HACRES
POS-HACRES-2097-09/20-1
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MEDICATIONS HOUR
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Diabetic Literal Order text +
instructions
Check Blood Pressure Daily and
Notify Physician if SYS >100 and
DIA >100 Consistently.
Weekly on Wed
Take One Tablet By Mouth Once
Daily
1000272Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily. Format #TFLBL560.
Drug Like: 1000280Rx#
KLONOPIN
REFILLS REMAINING #0
Take one tablet daily
Drug Like: 1000262Rx#
CARDIZEM CD
REFILLS REMAINING #0
Instill 2 Drops Each Ear Before
Bed
1000226Rx#
REFILLS REMAINING #0
Use as Directed
1000260Rx#
REFILLS REMAINING #0
Take One Tablet By Mouth Once
Daily
1000273Rx#
REFILLS REMAINING #0
Happy Acres - LFPOF313 for PO-010 stock.
Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M.F 07/08/32 2097 EAST 1: W
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
EAR WAX DROP SOL 6.5% OT
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
09/30/2020 10/29/20
Benzodiazepines; Haldol; Penicillins; Fibrates;Allergic to bee and wasp stings
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
6 am
Weekly
Wednes
04/24/20
10a
06/02/20
07/11/18
02/12/14
8 PM
05/24/18
05/07/20
8 AM
Page 1
HACRES
POS-HACRES-2097-09/20-1
LFPOF313
Happy Acres - As Needed Meds
03/31/18 03/31/18Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
8 AM
12PM
12:00P
8AM
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
NDC #
Orig: 12/30/16 End:
ACTIVATE PRIOR TO ADMINISTRATION
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
NDC #00002411630
Orig: 08/30/16 End:
Take One Tablet Every Other Day
NDC #00378240201
Orig: 04/22/13 End:
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
NDC #63629474801
Orig: 11/24/15 End:
Take One Tablet By Mouth Once
Daily As Needed for Pain
NDC #00054801425
Orig: 04/22/13 End:
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
ACETAMIN TAB 325MG
Instill 2 Drops Each Ear Before Bed
(,,,8 PM)
NDC #60346038951
Orig:02/12/14
APPLY AS DIRECTED
NDC #00122087766
Orig:11/24/15
Take One Tablet By Mouth At Bedtime
(,,,7PM)
NDC #54569094600
Orig:04/22/13
12/29/16 FBS Bi-Monthly
12/29/16 Annual PPD unless previous positve reaction as
per facility policy.
12/29/16 Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
12/29/16 FLU VACCINE (If resident not allergic) Inject 0.
5ml I.M. once a year (Oct thru March)
412-492-9851
07/12/17 Test to print on LEFT side.
12/29/16 Use test strips (AccuCheck) to check blood
glucose levels 2 TIMES A DAY.
12/29/16 Check Blood Pressure Daily and Notify Physician
if SYS >100 and DIA >100 Consistently.
04/22/13 Skin Breakdown Prevention measures: Pressure
Reduction Matress Pad/Daily. Dangle heels off bed with
pillow.
12/29/16 I have reviewed and approve of the Comprehensive
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
LFPOF331LFPOF331
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MEDICATIONS HOUR ORDERS
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Happy Acres - As Needed Meds
03/31/18 03/31/18Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
8 AM
12PM
12:00P
8AM
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
NDC #
Orig: 12/30/16 End:
ACTIVATE PRIOR TO ADMINISTRATION
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
NDC #00002411630
Orig: 08/30/16 End:
Take One Tablet Every Other Day
NDC #00378240201
Orig: 04/22/13 End:
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
NDC #63629474801
Orig: 11/24/15 End:
Take One Tablet By Mouth Once
Daily As Needed for Pain
NDC #00054801425
Orig: 04/22/13 End:
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
ACETAMIN TAB 325MG
Instill 2 Drops Each Ear Before Bed
(,,,8 PM)
NDC #60346038951
Orig:02/12/14
APPLY AS DIRECTED
NDC #00122087766
Orig:11/24/15
Take One Tablet By Mouth At Bedtime
(,,,7PM)
NDC #54569094600
Orig:04/22/13
12/29/16 FBS Bi-Monthly
12/29/16 Annual PPD unless previous positve reaction as
per facility policy.
12/29/16 Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
12/29/16 FLU VACCINE (If resident not allergic) Inject 0.
5ml I.M. once a year (Oct thru March)
412-492-9851
07/12/17 Test to print on LEFT side.
12/29/16 Use test strips (AccuCheck) to check blood
glucose levels 2 TIMES A DAY.
12/29/16 Check Blood Pressure Daily and Notify Physician
if SYS >100 and DIA >100 Consistently.
04/22/13 Skin Breakdown Prevention measures: Pressure
Reduction Matress Pad/Daily. Dangle heels off bed with
pillow.
12/29/16 I have reviewed and approve of the Comprehensive
*** Treatments ***
EAR WAX DROP SOL 6.5% OT
HYDROCORT AC CRE 1%
VALIUM TAB 2MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Blood Pressure Check ***
*** Treatments ***
*** Plan of Care / Discharge Plan ***
LFPOF331LFPOF331
Happy Acres - As Needed Meds
03/31/18 03/31/18Dr. Ronald Smith
Dr. Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 HACRESEAST 1:108 W
Acute Schizophrenia;Hypothyroidism;Gastroesophageal Reflux Disease;Chronic Schizophrenia;
Body Pain;Congenital Hypothyroidism;Digestive System Signs and Symptoms
Benzodiazepines; Haldol; Penicillins; Fibrates;
Allergic to bee and wasp stings
Page 1(Continued on next page)
8 AM
12PM
12:00P
8AM
INFUSE NAFCILLIN 2GM/100ML NSS
OVER 60 MINUTES; MINI BAG PLUS
NDC #
Orig: 12/30/16 End:
ACTIVATE PRIOR TO ADMINISTRATION
Generic:Olanzapine Tab 7.5 MG
Take One Tablet After Breakfast;
Take One Tablet Before Bedtime.
NDC #00002411630
Orig: 08/30/16 End:
Take One Tablet Every Other Day
NDC #00378240201
Orig: 04/22/13 End:
DX:Chronic Schizophrenia
For:COUMADIN
Take One Tablet By Mouth Once
Daily
NDC #63629474801
Orig: 11/24/15 End:
Take One Tablet By Mouth Once
Daily As Needed for Pain
NDC #00054801425
Orig: 04/22/13 End:
NAFCILLIN 2GM IN 100ML NSS
zyPREXA 7.5MG-TABS
TRIFLUOPERAZ TAB 2MG
WARFARIN TAB 4MG
ACETAMIN TAB 325MG
Insomnia; Dizziness; Drowsiness; Asthenia; Dyspepsia;
Sudden Death; Cerebral Edema; Atelectasis; Circulatory
Tracheobronchial Calcification; Skin Necrosis; Gangrene of
Hepatitis; Azotemia; Pancytopenia; Agranulocytosis; Renal
LFPOF331LFPOF331
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATIONS HOUR ORDERS
MEDICATION REVIEWNURSE’S SIGNATURE
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Dapagliflozin Propanediol Tab 10Take One Tablet By Mouth Once DailyRX#1000267 RO#200099
DIABETIC LITERAL ORDER TEXT....
CHECK BLOOD PRESSURE DAILY AND NOTIFY PHYSICIAN IF SYS >100 AND DIA >100 CONSISTENTLY. WEEKLY ON WED
TYLENOLTake One Tablet By Mouth Once DailyRX#1000272 RO#200103
KLONOPINTake One Tablet By Mouth Twice Daily. Format # TFLBL448-G for TRX-016 Label.RX#1000250 RO#200088
KLONOPINTake One Tablet By Mouth Once Daily. Format # TFLBL692for TRX-081 Label.RX#1000280 RO#200108
CARDIZEM CDTake one tablet dailyRX#1000262 RO#200094
Insulin Lispro Soln Cartridge 10Use as DirectedRX#1000260 RO#200092
ZESTRILTake One Tablet By Mouth Once DailyRX#1000273 RO#200104
03/21/19.11 am
03/21/19
12/29/166 AMWEEKLYWEDNESD
04/24/2010a
04/12/17
06/02/20
07/11/18
05/24/18
05/07/208 AM
12/29/16 FBS Bi-Monthly
12/29/16 Annual PPD unless previous positve reaction
as per facility policy.
12/29/16 Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
12/29/16 FLU VACCINE (If resident not allergic) Inject
0.5ml I.M. once a year (Oct thru March)
03/21/19 Diabetic Literal Order text....
412-492-9851
07/12/17 Test to print on LEFT side.
12/29/16 Use test strips (AccuCheck) to check blood
glucose levels 2 TIMES A DAY.
12/29/16 I have reviewed and approve of the
Comprehensive Assessment, the Plan of Care, and the
Discharge Plan.
04/22/13 Skin Breakdown Prevention measures: Pressure
Reduction Matress Pad/Daily. Dangle heels off bed with
pillow.
05/06/13 Knee-High TED Stockings Bilaterally for
Swelling
12/29/16 Apply EUCERIN lotion to dry skin after bath.
May keep at bedside.
06/30/15 Regular 1200 cal with 100gm added fiber.
06/30/15 Regular, no added salt.
03/21/19 IV Literal text here...
03/21/19 Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
03/28/18 Prescriptions valid for 90 days.
_______________________________
07/01/20 07/31/20Ronald Smith
Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 EAST 1108 W
FARXIGA TAB 10MG
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic Schizophrenia;Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Happy Acres
1 CONT'D
Code Status
LFPOF343
Dapagliflozin Propanediol Tab 10Take One Tablet By Mouth Once DailyRX#1000267 RO#200099
DIABETIC LITERAL ORDER TEXT....
CHECK BLOOD PRESSURE DAILY AND NOTIFY PHYSICIAN IF SYS >100 AND DIA >100 CONSISTENTLY. WEEKLY ON WED
TYLENOLTake One Tablet By Mouth Once DailyRX#1000272 RO#200103
KLONOPINTake One Tablet By Mouth Twice Daily. Format # TFLBL448-G for TRX-016 Label.RX#1000250 RO#200088
KLONOPINTake One Tablet By Mouth Once Daily. Format # TFLBL692for TRX-081 Label.RX#1000280 RO#200108
CARDIZEM CDTake one tablet dailyRX#1000262 RO#200094
Insulin Lispro Soln Cartridge 10Use as DirectedRX#1000260 RO#200092
ZESTRILTake One Tablet By Mouth Once DailyRX#1000273 RO#200104
03/21/19.11 am
03/21/19
12/29/166 AMWEEKLYWEDNESD
04/24/2010a
04/12/17
06/02/20
07/11/18
05/24/18
05/07/208 AM
12/29/16 FBS Bi-Monthly
12/29/16 Annual PPD unless previous positve reaction
as per facility policy.
12/29/16 Activities as tolerated per plan of care.
May go on LOA w/ Medications unless contraindicated.
May be seen by Podiatrist, Optomotrist, or Dentist as
needed with Family Permission.
12/29/16 FLU VACCINE (If resident not allergic) Inject
0.5ml I.M. once a year (Oct thru March)
03/21/19 Diabetic Literal Order text....
412-492-9851
07/12/17 Test to print on LEFT side.
12/29/16 Use test strips (AccuCheck) to check blood
glucose levels 2 TIMES A DAY.
12/29/16 I have reviewed and approve of the
Comprehensive Assessment, the Plan of Care, and the
Discharge Plan.
04/22/13 Skin Breakdown Prevention measures: Pressure
Reduction Matress Pad/Daily. Dangle heels off bed with
pillow.
05/06/13 Knee-High TED Stockings Bilaterally for
Swelling
12/29/16 Apply EUCERIN lotion to dry skin after bath.
May keep at bedside.
06/30/15 Regular 1200 cal with 100gm added fiber.
06/30/15 Regular, no added salt.
03/21/19 IV Literal text here...
03/21/19 Coumadin literal order text here...
Prescriptions valid for 90 days.
_______________________________
03/28/18 Prescriptions valid for 90 days.
_______________________________
07/01/20 07/31/20Ronald Smith
Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 EAST 1108 W
FARXIGA TAB 10MG
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
*** Lab Work Orders ***
*** Ancillary Orders ***
*** Diabetic Literals ***
*** Fax Number ***
*** Accident Reports ***
*** Blood Glucose Monitoring ***
*** Plan of Care / Discharge Plan ***
*** Treatments ***
*** Diets ***
*** IVs ***
*** Coumadin Orders ***
*** Orders Valid for... ***
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic Schizophrenia;Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Happy Acres
1 CONT'D
Code Status
LFPOF343
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MEDICATIONS HOUR
MEDICATION REVIEWNURSE’S SIGNATURE
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MEDICATION REVIEWPHARMACIST’S SIGNATURE
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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Dapagliflozin Propanediol Tab 10Take One Tablet By Mouth Once DailyRX#1000267 RO#200099
DIABETIC LITERAL ORDER TEXT....
CHECK BLOOD PRESSURE DAILY AND NOTIFY PHYSICIAN IF SYS >100 AND DIA >100 CONSISTENTLY. WEEKLY ON WED
TYLENOLTake One Tablet By Mouth Once DailyRX#1000272 RO#200103
KLONOPINTake One Tablet By Mouth Twice Daily. Format # TFLBL448-G for TRX-016 Label.RX#1000250 RO#200088
KLONOPINTake One Tablet By Mouth Once Daily. Format # TFLBL692for TRX-081 Label.RX#1000280 RO#200108
CARDIZEM CDTake one tablet dailyRX#1000262 RO#200094
Insulin Lispro Soln Cartridge 10Use as DirectedRX#1000260 RO#200092
ZESTRILTake One Tablet By Mouth Once DailyRX#1000273 RO#200104
03/21/19.11 am
03/21/19
12/29/166 AMWEEKLYWEDNESD
04/24/2010a
04/12/17
06/02/20
07/11/18
05/24/18
05/07/208 AM
07/01/20 07/31/20Ronald Smith
Charles Gorman
(412)555-9999
(412)221-2424
7004025 06/21/16
Williams,Rita M. F 07/08/32 2097 EAST 1108 W
FARXIGA TAB 10MG
ACETAMIN TAB 325MG
CLONAZEPAM TAB 1MG
CLONAZEPAM TAB 1MG
DILTIAZEM CAP 180MG ER
HUMALOG INJ 100/ML
LISINOPRIL TAB 10MG
Benzodiazepines; Haldol; Penicillins; Fibrates; Allergic to bee and wasp stings
Acute Schizophrenia; Hypothyroidism; Gastroesophageal Reflux Disease; Chronic Schizophrenia;Body Pain; Congenital Hypothyroidism; Digestive System Signs and Symptoms
Happy Acres
1 CONT'D
Code Status
Side Effects: Urinary Tract Infection; Vulvovaginal Candidiasis; Cystitis
Side Effects: Hepatitis; Azotemia; Pancytopenia; Agranulocytosis
Side Effects: Drowsiness; Behavioral Problems
Side Effects: Drowsiness; Behavioral Problems
Side Effects: Dizziness; Headache; Asthenia; Pain; Edema; Vasodilation
Side Effects: Severe Hypoglycemia; Infusion Site Reaction
Side Effects: Syncope; Dizziness; Hypotension; Hyperkalemia
LFPOF343
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