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MED-PASS:  Designing Solutions for Senior Care

Nursing Visit Record - 100/pack


Availability: In stock

Price: $19.95
  • Buy 5-9 for $17.45 each and save 13%
  • Buy 10 or more for $15.35 each and save 24%

Use this two-part, carbonless form to document a concise skilled assessment with convenient check-offs, which are designed to save valuable nursing time. Prompts included to document a patient's condition in a variety of categories, including cardiovascular, neurological and digestive/nutrition. 


The popular form also meets the Conditions of Participation (CoPs), which includes documentation of Patient, Caregiver and/or Representative (if any) agreed with and participated in changes to the POC, plus space to document the coordination/plan and updates to the interdisciplinary care plan. 

  • Assessment areas include:
      • Vital Signs
      • Cardiovascular
      • Respiratory
      • Neurological
      • GU
      • Sensory
      • Skin
      • Digestive/Nutrition
      • Musculoskeletal
      • Pain
      • Infusion
      • Mental Health
      • Endocrine
  • A narrative area is provided for Skilled Intervention / Teaching / Patient / Caregiver Response and Coordination / Plan
  • Space to document Supervisory Comments for a LPN or Aide
Size 8-1/2 x 11-3/4
Unit Package of 100
Other Info Handwritten
Number of carbonless parts 2
Hole Punch 3 holes left, 2 holes top