Medical-Surgical
Assessments
, ACUTE MEDICAL/SURGICAL ISBARR
IDENTIFICATION Date: Time:
:
Room# Age: Sex: M/F
Weight: Height:
Physician: Nurse: Aid:
Family contact: Advanced Directive
SITUATION:
Date of Admission: Admitted From:
Admitting Diagnosis:
Status: Full Code DNR Other:
Vital Signs: B/P: HR: RR: SpO2: Room Air O2 at L/min Via:
Temp: Temporal Oral Tympanic
BACKGROUND:
Allergies: Latex Other: NKDA
Past Medical/Surgical
History:
Isolation Precautions: X Standard C Contact: Airborne Droplet
Safety Precautions: Aspiration Fall Seizures Other:
Additional Safety concerns/interventions:
Assistive Devices: None Walker Cane Wheelchair Other:
Transfer Devices:
Hearing Aids:(select one) Right Left Bilateral Dentures: (select one) Upper Lower Both
ADL Assist: Hygiene: Nutrition/Diet:
ASSESSMENTS:
Neurological Alert Oriented to: Person Place Time Situation
Respiratory Room Air O2 via: at L/min
Cardiovascular Pacemaker Other:
Gastrointestinal
Genitourinary
Acute Medical/Surgical Assessment Page 2 of 1
Assessments
, ACUTE MEDICAL/SURGICAL ISBARR
IDENTIFICATION Date: Time:
:
Room# Age: Sex: M/F
Weight: Height:
Physician: Nurse: Aid:
Family contact: Advanced Directive
SITUATION:
Date of Admission: Admitted From:
Admitting Diagnosis:
Status: Full Code DNR Other:
Vital Signs: B/P: HR: RR: SpO2: Room Air O2 at L/min Via:
Temp: Temporal Oral Tympanic
BACKGROUND:
Allergies: Latex Other: NKDA
Past Medical/Surgical
History:
Isolation Precautions: X Standard C Contact: Airborne Droplet
Safety Precautions: Aspiration Fall Seizures Other:
Additional Safety concerns/interventions:
Assistive Devices: None Walker Cane Wheelchair Other:
Transfer Devices:
Hearing Aids:(select one) Right Left Bilateral Dentures: (select one) Upper Lower Both
ADL Assist: Hygiene: Nutrition/Diet:
ASSESSMENTS:
Neurological Alert Oriented to: Person Place Time Situation
Respiratory Room Air O2 via: at L/min
Cardiovascular Pacemaker Other:
Gastrointestinal
Genitourinary
Acute Medical/Surgical Assessment Page 2 of 1
