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Patient admission check list
Patient Admission Checklist
Patient Information
Name
Date of birth
Address
Phone number
Emergency contact
Medical History
Allergies
Current medications
Past surgeries
Chronic medical conditions
Family history of medical conditions
Insurance Information
Insurance provider
Policy number
Group number
Primary care physician
Consent Forms
HIPAA consent
Financial responsibility
Treatment consent
Release of information
Physical Examination
Vital signs
Height and weight
General appearance
Skin assessment
Medication Reconciliation
List of current medications
Dosages
Frequency
Last administration time
Admission Orders
Diet
Activity level
Medications
Laboratory tests
Imaging studies
Discharge Planning
Follow-up appointments
Home care services
Medication instructions
Contact information for questions
Patient Education
Post-discharge care
Medication management
Signs of complications
Emergency contact information
Informed Consent
Explanation of procedures
Risks and benefits
Alternative options
Patient signature and date
Physical Therapy Evaluation
Mobility assessment
Strength testing
Range of motion evaluation
Assistive device needs
Nutritional Assessment
Dietary restrictions
Nutritional goals
Food preferences
Meal schedule
Psychosocial Assessment
Support system
Mental health history
Coping mechanisms
Stressors
Pain Assessment
Pain level
Location
Quality
Duration
Fall Risk Assessment
History of falls
Gait assessment
Balance testing
Environmental hazards
Infection Control Assessment
Hand hygiene practices
Isolation precautions
Wound care instructions
Education on preventing infections
Cultural Assessment
Language preferences
Religious practices
Dietary restrictions
Beliefs about healthcare
Safety Assessment
Bed rails
Call bell access
Fire evacuation plan
Personal belongings storage
Personal Care Needs
Bathing preferences
Toileting assistance
Dressing assistance
Mobility aids
Equipment Needs
Wheelchair
Walker
Oxygen
Bedside commode
Environmental Assessment
Room temperature preferences
Lighting preferences
Noise level preferences
Room cleanliness
Documentation
All assessments completed
Informed consents signed
Admission orders entered
Discharge planning initiated
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