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Patients Chart

This document contains a patient chart template for the Philippine National Police Health Service Regional Medical and Dental Unit 1. It collects personal information about the patient such as name, age, sex, unit/address, contact details, and dependent information if applicable. It also includes checklists for common symptoms and medical conditions. Vital signs will be recorded as well as results from medical tests, exams, and procedures. The purpose of the visit and chief complaint is noted. The duty nurse signs off after filling out the chart.

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Lovely Hackey
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We take content rights seriously. If you suspect this is your content, claim it here.
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1K views1 page

Patients Chart

This document contains a patient chart template for the Philippine National Police Health Service Regional Medical and Dental Unit 1. It collects personal information about the patient such as name, age, sex, unit/address, contact details, and dependent information if applicable. It also includes checklists for common symptoms and medical conditions. Vital signs will be recorded as well as results from medical tests, exams, and procedures. The purpose of the visit and chief complaint is noted. The duty nurse signs off after filling out the chart.

Uploaded by

Lovely Hackey
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines

NATIONAL POLICE COMMISSION


PHILIPPINE NATIONAL POLICE, HEALTH SERVICE
REGIONAL MEDICAL AND DENTAL UNIT 1
Camp BGen Oscar M Florendo, Parian, City of San Fernando, La Union
09686766319

NO:___________

PATIENT’S CHART
Rank/Name : _________________________________________ Badge No.:_____________________
Age/ Sex :_________ Date of Birth:_______________________
Unit/Address:__________________________________________ Contact Number: ___________________
Dependent of (For PNP and NUP dependents):______________________________
Contact No.:_____________________
Checklist for pertinent findings to be filled out and duly signed by PNP/NUP/Dependents/Civilians.
( ) Difficulty of Breathing ( ) Fever ( ) Injury/ Surgery/ Operation/Fracture less than 1year
( ) Chest pain ( ) Cough and Colds ( ) Hypertension ( ) Hypercholesterolemia/
( ) Diarrhea ( ) Sore Throat ( ) Diabetes Mellitus Hyperuricemia/ Fatty Liver
( ) Dizziness ( ) Travel History ( ) Other diseases (specify): _____________________
( ) History of COVID-19 infection:______________ ( ) Medications: _______________________________
( ) Primary vaccine (identify):_________________ __________________________________________
( ) Booster vaccine (identify):_________________ __________________________________________

________________________
Printed name over Signature

Date/ Time : __________________ Purpose: ________________________


Chief Complaint: ________________ Name of Schooling: ________________
VS- BP: _______ RR: ________ PR: _______ Weight: ______ Temp: ______ O2Sat: ______
Height: _______ BMI: ________
CBC:______ Others (as required):
FBS:______ Na:______ SGPT:________
Crea:_______ K:________ SGOT:________
Urinalysis:_______ Hba1c:______ Ultrasound:_________
Chest Xray:_______ OGTT 75gms:_______ 2D echo:________
ECG:____________ Lipid profile:_______ Other test (identify):
*PT(female):____________ Uric Acid:_________ _____________________
OB Score: G__P__(_____)

_____________
Duty Nurse

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