Update An Inpatient Record for
{{ client.fname }} {{ client.lname }}
Reporting Unit:
{{ records.unit_id}} -- {{ records.unit_lname }}
{% for unit in units %}
{{unit.unit_id}} -- {{ unit.unit_lname }}
{% endfor %}
Inpatient Admission:
Discharge (If Applicable):
Hospital Name:
Hospital Address:
State Hospital:
No
Yes
Hospital Type:
{{ records.hospital_type }}
Medical
Psychiatric
Other
Staff Name:
Staff Shift:
Time Of Day:
Specific Complaint:
{% if records.complaint %}
{{ records.complaint }}
{% endif %} {% set all_options = [ "Abdominal Pain", "Agitation", "Alcohol Intoxication", "Allergic Reaction", "Anxiety", "Asthma", "Back Pain", "Bizarre Behavior", "Breathing Issue", "Cellulitis", "Chronic Obstructive Pulmonary Disease (COPD)", "Chest Pain", "Coronary Artery Disease (CAD)", "Congestive Heart Failure (CHF)", "Congestion ", "Cough", "Depression", "Diabetic ulcer ", "Dizziness", "Ear Infection", "Emphysema", "Evaluation", "Fainting", "Fall", "Fever", "Flu", "Fracture ", "Gastrointestinal Illness", "Glucose Levels ", "Gout ", "Hallucination", "Headache", "Homicidal Ideation", "Infection", "Irritable Bowel Syndrome (IBS)", "K2", "Medication Error", "Nausea", "Pneumonia ", "Rash", "Rectal Bleeding", "Respiratory Failure", "Seizure", "Sickle Cell ", "Sore Throat", "Stomach Pain", "Substance Abuse Relapse", "Suicidal Ideation", "Unconscious", "Upper Respiratory Infection", "Urinary Tract Infection (UTI)", "Vomiting", "Weakness", "Wound", "Other" ] %} {% for complaint in all_options %} {% if complaint != records.complaint %}
{{ complaint }}
{% endif %} {% endfor %}
Reason For Visit (Detail):
EOB Visit:
{{ records.eob }}
No
Yes
Admission / Visit Type:
{{ records.voluntary }}
Voluntary
Non-Voluntary
Escort Type:
{{ records.escort_type }}
EMT
Police
Self
Staff
Transportation Type:
{{ records.transport_type }}
Agency Vehicle
Ambulance
Ambulette
Police Vehicle
Public Transportion
Staff/Agency Vehicle
Client Age At Time Of Visit:
Client Sex:
Diagnosis:
Outcome (If Applicable):
Comments:
{{ records.comment_text }}
Submit
{% include '_footer.html' %}