Wiki Spaces

Documentation
Projects
Resources

Get Help from Others

Q&A: Ask OpenMRS
Discussion: OpenMRS Talk
Real-Time: IRC Chat | Slack

Projects

Page tree

BASIC PATIENT INFORMATION

Ward #: ______  Bed #:______

Name:  Surname_____________________   Given names_____________________

Sex: Male  Female                A ge [_____]  years or  months (for children < 1 y)

Is patient pregnant?   YES or  NO/UNKNOWN 

       If YES , which trimester first      second     third

 

PRESCRIBER INFORMATION

Name of prescriber: _____________________ Prescriber ID #: _____________________           

 

 

 

 

MEDICATION

*NOTE: This is not what the paper form, but does contain the same information.

Also, for each medication selected: list strength, frequency, and form (oral, injected, or rectal)

Admissions pack     

Antimalarials                                                                 Other

    Artemether-Lumefantrine (ACT)                             Multivitamin tablets

    Artusunate                                                                   Ivermectin

    Artemether                                                                  Zinc sulphate

Antibiotics                                                                       Diazepam                                                                   

    Ceftriaxone                                                                  Ondansetron

    Cefixime                                                                       Haloperidol

      Metronidazole                                                           Chlorpromazine

Analgesics/Antipyretics                                               Omeprazole

    Paracetamol                                                                Ranitidine                                                                 

    Tramadol                                                                     Other (list)___________________                                      

    Morphine