This document appears to be a medical chart containing sections for a patient's room number, name, code status, allergies, diagnoses, vital signs, breakfast, lunch and dinner, and notes on their mental status, neurology, respiratory, cardiac, musculoskeletal, gastrointestinal/genitourinary, skin, labs/tests/procedures, and new orders. The chart includes blank lines under each section for recording the corresponding information and observations for up to two patients.

1. Room:____________Name:______________________
Code Status:_________ Allergies:_________________
DX: 8
Mental Status:
VS: 8A 12P 16
10
BS:Bfast Lunch: Din:
Neuro: 12
Resp:
Cardiac: 14
Mus/Skel:
GI / GU: 16
Skin:
Labs/Tests/Spec:
18
New Orders
========================================
Room:____________Name:______________________
Code Status:_________ Allergies:
8
DX:
Mental Status:
VS: 8A 12P 16 10
BS:Bfast Lunch: Din:
12
Neuro:
Resp:
14
Cardiac:
Mus/Skel
16
GI / GU
Skin:
Labs/Tests/Spec:
New Orders 18