Standard Admit Orders

Page by: E.J. Mayeaux, Jr., M.D.
Louisiana State University Medical Center Shreveport, Louisiana

1. Admit to (Service) (Attending/Resident/Intern Name)
2. Diagnosis:
3. Condition: (Stable/Guarded/Critical)
4. Vitals: (Routine/Q shift/Q4 hours)
5. Allergies: (NKDA)
6. Nurses instructions:
7. Diet: (Regular, 1800 ADA, 2gm or 4gm Na+)
8. Activity: (BRcBRP, Ad lib)
9. Lab: (CBCcd&p, A-8, SMA, PT/PTT, CXR, U/A, EKG, DXT's, Ca-Mg-PO4)
10. Meds: (Drug, dose, frequency)
11. PRN Meds: (MOM, Mylanta, Tylenol, Benzodiazepine)
12. Additional Orders:
• IV orders: (Type at cc/hr or hr rate)
• DXT (AC and HS, Q4 hours, Q6 hours)
13. Alcohol (DT) Precautions:
• B12 1000ug IM now & in M
• Vit. K 10mg IM now & qAM x3
• Folate 1mg PO qday x4
• MVI 1 PO qday
• Thiamine 100mg IM qday x3
• Librium 25mg Po q6hrs PRN agitation
• Lab: Mg, ETOH level, PT/PT
14. Sliding Scale Regular Humulin:
• <200 do nothing
• 200-300 5u SQ
• 300-400 10u SQ
• > 400 call MD