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Clothing and Personal Effects List

The document is a valuables list for patients at Morrison Community Hospital, detailing items to be stored safely during admission and discharge. It includes sections for personal items, assistive devices, jewelry, and non-formulary medications. Both the patient and nursing staff must verify and sign off on the list at admission and discharge.

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Kara garcia
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5 views2 pages

Clothing and Personal Effects List

The document is a valuables list for patients at Morrison Community Hospital, detailing items to be stored safely during admission and discharge. It includes sections for personal items, assistive devices, jewelry, and non-formulary medications. Both the patient and nursing staff must verify and sign off on the list at admission and discharge.

Uploaded by

Kara garcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Valuables List

 Glasses Wallet  Electric Razor


Cash _________(to be
stored in Hospital safe)
 Contacts  Purse  Laptop
 Cell phone  Ring/s (describe)  Hearing Aid:
 Cell phone #________
_________________
___ Right
___ Left
charger
_________________
 Dentures:  Assistive Device  Jewelry (other than
___ Upper ____Walker rings)
___ Lower ____Cane ____Watch
____Wheelchair ____Necklace
____Other (Describe) ____Earrings
___________________ ____Other (Describe)
___________________ _______________________
_____________

 Valuables in Hospital Safe: _____________________________________________


_____________________________________________
_____________________________________________
_____________________________________________
 Non formulary Medications
(must be sent to pharmacy for verification): _________________________________________
_____________________________________________________
_____________________________________________________
_________________
_________________________________________

Complete on Admission: Complete on Discharge:

Nurse and Patient/Responsible party to Nurse and Patient/Responsible party to


verify present on Admission: verify present on Discharge:

Signed:__________________________ Signed:___________________________
(Patient or responsible party) (Patient or responsible party)
Date Date

Witness:_________________________ Witness:_______________________
(Nursing Staff) (Nursing Staff) Date
Date

Morrison Community Hospital


Med/Surg/Swing 02/2013
Morrison Community Hospital
Med/Surg/Swing 02/2013

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