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EKG (and other special test)<br />

EKG Reports<br />

J008 EKG Strips<br />

Echocardiography Report<br />

J282 Adult Echo Report<br />

J527 Adult Echo Report<br />

Transesophageal Echocardiography Flow Sheet (blue)<br />

J536 Transesophageal Echo Monitoring Report<br />

J397 Stress Test Report<br />

Holter Monitoring Report<br />

To be put in date order:<br />

H312 EEG Report<br />

Electromyography<br />

J319 NCV Nerve Conduction Velocity<br />

J344 Bone Marrow Processing forms<br />

J429 Adult Bone Mineral Density<br />

J430 Pediatric Bone Mineral Density<br />

J566 Evoked Potential Report<br />

Multi-channel Sleep Recording Report<br />

J401 Sleep Study Report<br />

J664 Cardiopulmonary Exercise Test Report<br />

OB High Risk form<br />

Antepartum Testing<br />

Respiratory/ Rehabilitation<br />

J817 Initial Evaluation<br />

J070 Resp. Therapy Tx Record<br />

J089 Resp. Therapy Ventilator Record<br />

J316 Pediatric Ventilator Record<br />

J541 BiPap S/T Record<br />

H331 Spirometry & Lung Volume<br />

H538 Rehabilitation Progress Notes<br />

H789 Asses. Plan of Care & Progress Notes<br />

J959 Gait Training<br />

J952(1&2) Splint Evaluation<br />

J474 Respiratory Care Services Metabolic Study<br />

D912 Bronchial Hygiene Evaluation<br />

H330 Pulmonary Function Test<br />

J321 Pulmonary Function Studies<br />

Pulmonary Function Report<br />

J432 Hyperbaric Oxygen Therapy H&P Screen<br />

J433 Record of Hyperbaric Treatment Exposure<br />

J955 Physical Therapy Cardiac Evaluation<br />

J951 Cardio Pulmonary/Transplant Evaluation<br />

J395 Rec. Therapy Initial Assess. & Activity Evaluation<br />

J667 Occupational Therapy Evaluation<br />

Radiology/Radiation/Nuclear Medicine<br />

Radiology Reports<br />

J264 Radiology Special Procedures<br />

J408 Duplex Ultrasound Cerebrovascular Exam<br />

J172 Tx/Implant Summary<br />

Radiation Implant Summary<br />

Laboratory<br />

Laboratory Report papers (originals)<br />

Outside labs (outside referrals)<br />

PKU results (stick on another sheet)<br />

Hemodialysis<br />

D350 Hemofiltation Flow Sheet<br />

J425 Peritoneal Dialysis<br />

Continuous Renal Replacement Therapy<br />

J125 Drug Monitoring<br />

To be put in form # order H before J<br />

H249 Virology<br />

H489 Cytopathology Consultation<br />

H031 Coagulation<br />

H035 Bacteriology<br />

J326 Histopathology<br />

J339 Drugs of Abuse Screen<br />

J349 Serology Requisition (if HIV + only)<br />

J496 Cytogenetics Report<br />

J497 Molecular Diagnostic Lab report<br />

J498 Flow cytometry Lab<br />

J532 Laboratory Consultation<br />

J579 Cytopathology Report (file w/surgery if matches date)<br />

Vascular Lab<br />

Nursing Notes<br />

J599 ED Nursing Care Record<br />

J491 ED Nursing Care Record Continuation<br />

Level of Care Scoring System<br />

J494 Trauma/Critical Care Nursing Record<br />

J491 Trauma/Critical Care Nursing Record Cont.<br />

J372 Nursing Neonatal Transport Flowsheet<br />

J521 23 Hour Admission Record<br />

J538 Pediatric 23 Hour Admission Record<br />

J015 Nursing Data Base/Shift events update (All except for Psych)<br />

J1046 Pt Care Observation/Assessment*<br />

J011 Neonatal ICU Nursing History<br />

J014 Nursing Care Plan (Kardex)<br />

J445 Patient Care Plan Continuation<br />

J597 PACU Standard Care Plan<br />

J806 PACU Acuity<br />

J690 Patient Care Plan<br />

J691 a,b,c Patent Care Plan Continuation<br />

J695 Diagnostic Imaging Nursing Notes<br />

J520 Psychiatry nursing Rounds<br />

J687 Nursing Group Notes –Psychiatry<br />

J1025 Inpt. Psychiatry Group Therapy Notes<br />

J092 Neurological Flowsheet<br />

J332 Neurovascular Assessment<br />

J368 Transitional Nursery Flowsheet<br />

J292 Patient Care Record<br />

H962 Pediatric Patient Care Record<br />

J005 Burn Unit Nursing Notes<br />

J006 Estimation of Size of Burn by Percent<br />

J391 Nursing Evaluation<br />

J462 Nursing Initial Shift Assessment<br />

J335 Antepartal Nursing Discharge Summary<br />

J336 OB/Newborn Nursing Discharge Summary<br />

J241 Pediatric Patient Summary<br />

Teaching Sheet<br />

J1078 Interdisciplinary Patient/Family Education<br />

H440 Home Health<br />

Medication Records<br />

J359 Pain Management Medication Record<br />

J386 Notice of Sedation<br />

J1003 A&B Ped, Critical Care & Sedation Service<br />

Frequent Assessment Monitoring Records<br />

J525 PCS Paper (medication sheet)<br />

J1099 Pain Assessment Management Flow Sheet<br />

J359 Pain Management PCA Flow Sheet<br />

J962 Amin. & Vanc. Pharmacokinetic Monitoring<br />

Graphics<br />

J110 Emergency Transfusion Request & Release<br />

ED Transfusion Record<br />

H964 Blood Bank Transfusion Reaction<br />

H288 Transfusion Reaction Report<br />

J485 Vital Signs Flowsheets<br />

J486 Intake/Output Flowsheets<br />

J071 Intake Flowsheet<br />

J696 ECMO Laboratory Flowsheet<br />

J697 ECMO Flowsheet<br />

ECMO Shift<br />

CT ICU Flowsheet<br />

J475 Initial Nutrition Assessment<br />

J483 Nutritional Flow Sheet<br />

J009 Sedative Hypnotic Withdrawal Sticker<br />

J115 OPIOD Drug Withdrawal<br />

H152 Labor Flowsheet<br />

H959 Special Fluid Balance Record<br />

H960 Newborn Data Flowsheet<br />

H961 Special Clinical Nurses Record<br />

J221 Seizure Flowsheet<br />

J261 Pediatric ICU Flowsheet<br />

J262 Pediatric ICU Flowsheet<br />

J905 PT. Event Record<br />

D255 Initial Phy Assess. For Behavioral Health Care<br />

J518 Restraint Flowsheet<br />

Authorizations<br />

H318 Authorization for Special Procedures<br />

WOO4 Request for Restrictions Regarding Treatment, Payment and Health Care Operations<br />

J1101 Consent for Treatment of Cancer with Chemotherapy<br />

H321 Authorization for Autopsy<br />

H322 Authorization for Leaving the Hospital AMA<br />

H324 Authorization for Therapeutic Abortion<br />

H326 Authorization for Disposal<br />

H328 Authorization to Take Photographs<br />

H357 Authorization for Removal of Anatomical Gifts<br />

Consent for Bereavement Services<br />

H906 Bequeathal of Body<br />

J127 Authorization for Neonatal Transport<br />

J299 Perinatal Sibling Visitation Record<br />

J427 Auth. to Allow Others to Interact with Infant/Child<br />

J431 Auth. For Release of Birth Announc. To the Media<br />

J436 Temporary Release form the Hospital<br />

J438 Reverse Transport Agreement<br />

J468 Hepatitis B Vaccine<br />

J489 Voluntary Consent to Hepatitis B Vaccine<br />

J559 Newborn Screen Informed Release<br />

J602 Vaccine Consent<br />

Rejection of Blood Transfusion<br />

LB146 Newborn Maturity Rating and Classification<br />

Weight Chart<br />

J567 Premature Infant Growth Chart<br />

Valuables Release<br />

Newborn Identification Record (foot)<br />

Birth Certificate (all four forms)<br />

Hearing Risk Screen<br />

Death Certificate (all three forms)

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