<p> Admitting Worksheet for Skilled Patients Date & Time Patient Name: Current location: Situation ETA: Recent medical diagnosis/surgical procedure:</p><p>Background Date of onset: PMH:</p><p>Age: Sex:  M  F Allergies:</p><p>Documents Received:  History and Physical Assessment  Discharge summary  All therapy notes  Discharge provider’s orders  All labs and x-rays (EKG, echo, catscan, etc. as applicable)  Discharge medication list/orders Assistive Device:  platform walker  4-wheeled rollator  FWW  Quad cane Recommendations  single-point cane  BSC  Wheelchair Other needs:  Air mattress  Trapeze bar  Supplemental O2  Other: ______</p><p>Services Ordered:  PT  OT  ST  RT</p><p>Other considerations:</p><p>All necessary staff notified:  nursing  therapy  office  AFC Follow-Up  respiratory  radiology  lab  pharmacy</p><p>Form seen by:  Admitting Physician  ______ ______</p>