تسجيل الدخول
ليس لديك حساب؟
إعدادات الفورم
Show patient signature field in the form
لوحة الإدارة - حسابات المستخدمين
لوحة الإحصائيات
إجمالي النماذج المسجلة: 0
Triage Screening for Early Recognition of Communicable Diseases
1. Have you had fever (elevated temperature)?
2. Have you had a rash or unusual skin lesion?
3. Have you had cough, shortness of breath or difficulty breathing?
للمرضى الذين لديهم أعراض حمى / تنفسية / طفح جلدي
4. Traveled outside Saudi Arabia or close contact with a traveler?
5. Are you a healthcare worker with recent exposure?
6. Close contacts with similar symptoms?
Actions (if positive screen)
General Information
Received from
First Visit
Interpreter needed?
Transportation
Initial Nursing Assessment
Nutritional screen: unintentional weight change in past 6 months?
Psychological & Social Screening
Pain Screening
Pain Scale (0-10)
Neurological Screening
AVPU scale — check all that apply.
Functional Assessment
Fall Risk Screening Tool
If the answer to any of the questions is Yes, the patient is considered at risk for fall.
Have you had a fall in the past 3 months?
Do you have difficulty in walking?
Do you use an assistive device (walker, cane, brace)?
Do you receive any of the following medication?
Fall Risk Interventions
توقيع المريض الإلكتروني
تأكيد وحفظ
الممرضة المسؤولة عن تسجيل هذا النموذج: