James, Patricia dob 02/01/1926 77 & 1/12 y/o 3-2-03

941-0000 000-0000 Hospital MR #00000

Mercy Folsom Hospital, Med Surg Ward

983-7460, Fax 983-7548

Orders

1 Admit to hospital service of John Smith, MD

2 Dx: chest pain

3 Telemetry

4 Meds:

a tylenol 650 mg po q 4 hr prn pain or fever

b MOM 30 cc po hs prn constipation

c mylanta 30 cc po qid prn heartburn

d ativan 0.5 mg po 1-2 tid prn anxiety or insomnia

5 CBC, comprehensive metabolic panel, ESR, UA, C&S if indicated

6 XR tests:

7 Diet, npo for now

8 intravenous fluids:

9 Foley catheter

10 Bathroom privleges and activity ad lib

11 Discharge planner consult

12 code status: full code

13 observation status for the first 22 hours, but if not discharged by then, please convert to in-patient status

14

John Smith, MD Sunday, 3/2/03 6:43 PM