|
These forms require Adobe Acrobat Reader, which is free. If you don't
already have the Acrobat Reader, it can be found here.
Pre-Admission/Registration
Form
You and your physician can use this form to provide Hilo Medical Center
with the information we will need to prepare for your visit.
Completing this form fully will help streamline the process of your admission
or registration. Fax it to (808) 974-6869 and bring a copy with you on
the day of your procedure.
Forms for the physician and physician's office.
Diagnostic Imaging Requisition
Surgery Requisition
Physician Orders
These forms are provided for reference only. Please use the Standard Register forms for inclusion in the medical record.
322-0002 ANESTHESIA RECORD rev 08-07
322-0007 CODE STATUS rev 08-05
322-0107 RECORD OF DEATH FORM rev 10-07
322-0263 RESTRAINT SECFUSION ORDER FORM re 10-07
322-0296 INHOUSE TRANSFERS rev 10-08
322-0305 DRS HIRATA AND EBESUGAWA ORDERS rev 07-07
322-0342 TRANSFERS BETWEEN UNITS rev 08-08
322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
322-0561 HYSTERECTOMY MD ORDERS rev 09-04
322-0566 VACCINE CONSENT-DOCUMENTATION TOOL rev 04-08
322-0567 COMMUNITY ACQUIRED PNEUMONIA (CAP) SEVERITY SCORE TOOL rev 10-05
322-0578 PHYSICIAN AND NURSING DISCHARGE INSTRUCTION DOCUMENTATION rev 07-07
322-0581 DRS PIERCE PATTERSON POST OP ORDERS 08-08
322-0582 INSULIN SLIDING SCALE 02-08
322-0591 PREOP ORDERS FOR DRS PIERCE & PATTERSON 04-07
322-0597 ISCHEMIC STROKE MD ORDERS rev 04-08
322-0599 RESPIRATORY THERAPY ORDERS rev 03-06
322-0604 HALE HO'OLA PREPRINTED ADMIT ORDERS rev 11-07
322-0607 CERTIFICATE OF TRANSFER rev 06-05
322-0619 MATSUURA POST OP HIP ORDERS rev 04-07
322-0631 ALCOHOL DETOX PROTOCOL rev 03-06
322-0646 EEG ORDER FORM rev 06-08
322-0659 ER THROMBOLYTIC ISCHEMIC STROKE ORDERS rev 04-08
322-0667 NIS SCALE rev 07-08
322-0669 MRI PATIENT SCREENING FORM rev 11-05
322-0687 DEEP VENOUS THROMBOSIS ver 04-06
322-0706 COMFORT CARE ORDERS rev 04-07
322-0728 RAPID RESPONSE RECORD rev 08-07
322-0729 BASAL INSULIN MAINTENANCE ORDERS rev 05-07
322-0732 TELEMETRY ORDERS rev 09-07
322-0737 SNF-ICF LEVEL OF CARE ORDERS rev 07-08
322-0751 SURROGATE FORM rev 05-07
322-0752 WITHDRAWAL OF NUTRITION CONSENT rev 05-07
322-0753 NITTA BLANK CONSENT FORM rev 05-07
322-0754 NITTA PITOCIN rev 05-07
322-0770 VAD ASSESSMENT rev 08-07
322-0773 RT-PHARMACIST DRUG ORDER CHANGE rev 08-07
322-0776 RT PHARMACY MED FORM rev 08-07
322-0778 ORAL WARFARIN ORDERS rev 04-08
322-0782 CCU ADMIT ORDERS rev 10-07
322-0791 DR SANTIAGO'S POST OP ORDERS rev 12-07
322-0806 DR SANTIAGO PATIENT INTAKE FORM rev 04-08
322-0807 IMAGING ORDER FORM rev 01-07
322-0809 OB H&P FORM rev 02-08
322-0811 DRS PIERCE AND PATTERSON SURGERY ADMISSIONS rev 03-08
322-0840 CAP ORDERS & SCORING SHEET rev 08-08
322-0841 CARDIAC ADMIT ORDERS rev 10-08
322-0917 HEPARIN INFUSION ORDERS rev 07-08
322-0919 PRE CATH ORDERS rev 06-08
322-0920 POST ANGIO ORDERS rev 06-08
322-0921 POST CORONARY INTERVENTION ORDERS rev 06-08
322-0922 NEWBORN ANTIBIOTIC ORDERS rev 06-08
322-0923 PERSANTINE CARDIAC NUCLEAR SCAN DR SAMMOND rev 06-08
322-0924 LTC UTI PROTOCOL FAX rev 08-08
322-0925 DONOVAN POST C SECTION rev 08-08
322-0926 DONOVAN PRE OP C SECTION rev 10-08
322-0927 DONOVAN ANTEPARTUM rev 08-08
322-0929 VTE ABX rev 08-08
322-0930 INITIAL INFANT STABILIZATION FORM rev 10-08
322-0931 CIRCUMCISION PROCEDURE NOTE 8.08
322-0932 NURSERY IDT PROGRESS NOTE rev 08-08
322-0935 MAG SULFATE PRETERM LABOR rev 10-08
322-0936 MAG SULFATE FOR PIH rev 10-08
322-0937 REQUEST FOR PLACENTA FORM rev 08-08
322-0940 PICC ORDER FORM rev 10-08
|
