Camper name: ______________________________________________
______________________________________________
Introduction: The standing orders or nurse-initiated orders are medications and/or activities approved by a camp-consulting physician. Medications listed are PRN (as needed) and exemptions to the medication administration of the said drug(s) include the following: 1) Those with allergies, sensitivities or questionable reactions 2) Is currently taking a medication that is contraindicated with the said drug 3) Has been prescribed a medication by a physician for the symptom being treated 4) Causes extreme drowsiness or any other side effect that is less desirable then the reason for taking the drug 5) Parents, guardians, family physician may reject the standing orders for any reason or cause. A "12 hour period" refers to continuous administration during a 12-hour period ex. q 4-6 h. med given every 4 or 6 h. in 12 hours. "Guardians" refers to traditional definition and may include any institutional or Adult Residential Centre facility etc. where the camper may reside. We only require the signature from either the camper's Physician or from the camper's guardian.
Consent I have read and authorize the attached: Camp Physician's Signature:________________________________ Camper Physician's Signature:______________________________ OR Guardian Signature:______________________________________ Date:____________ Camp Nurse: __________________________________
Camper name: ______________________________________________
______________________________________________
Adult Camper
Activity as tolerated Diet as tolerated Acetaminophen 325-650mg po/pr q4-6hr for pyrexia (fever) x2 Acetaminophen 325-650mg po/pr for minor aches and pains, menstrual cramps, headache ASA 325-975mg po/pr for pyrexia if unable to take acetaminophen Solarcaine cream/spray or equivalent for sunburn Calamine/Caladryl for itchiness due to insect bites Benadryl 25mg po for symptoms of hay fever Gravol 50-100mg po/pr for nausea/vomiting q6hr x 12hr Over the counter antibiotic preparations for infected wounds with no previous treatment plan Maalox 15-30 cc po for indigestion Kaopectate 1200mg for diarrhea or loose, malodorous bowel movement Stock cough syrup at recommended dosage Consent
I have read the attached and authorize Schedule B
Camp Physician's Signature: _____________________________________ Camper's Physician's Signature: ___________________________________
Guardian Signature ____________________________________________ Date: ____________ Camp Nurse: ________________________________________ Please read and sign as applicable to the specific camper. If not applicable for camper, put a diagonal line through the order and sign the page.
Camper name: ______________________________________________
Consistency with plans at home/facility or requested by family physician. If no plan is given, the following will be followed and adjusted to individual needs. If no bowel movement x 2 days, and is abnormal per usual pattern, then: push fluids, encourage activity, dried or fresh fruit. If no bowel movement x 3 days, previously prescribed oral laxative; if no prescription then continue with fluid push, Magnolax 7.5-15 ml (adults), Magnolax 1-10 ml (children) po, followed by or mixed with 240 cc water or milk at bedtime and rectal check. If no bowel movement x 4 days, then rectal check, glycerine or Dulcolax suppository, repeat laxative. If no bowel movement x 5 days, rectal check, abdominal assessment, disimpaction or fleet enema (action depends on camper, assess and rectal touch). How often does client have a normal bowel movement on average? ___________________ Are aggressive measures e.g. suppositories, laxatives, enemas etc necessary to achieve this? Yes
Consent
I have read the attached and authorize Schedule C
Camp Physician's Signature: _____________________________________ Camper's Physician's Signature: ___________________________________
Guardian Signature ____________________________________________ Date: ____________ Camp Nurse: ________________________________________ * Please read and sign as applicable to the specific camper. If not applicable for camper, put a diagonal line through the order and sign the page.
Actos, asambleas, concentraciones manifestaciones convocados por CCOO para celebrar el Día Internacional de la Mujer Las actividades que realizan las secretarías de la Mujer de CCOO de las Comunidades Autónomas y de las Federaciones servirán para denunciar el agravamiento de las condiciones de vida y trabajo como consecuencia de la crisis económica, de la destrucción de empleo
UnitedHealthcare SignatureValueTM Offered by UnitedHealthcare of California 20/250a Performance HMO Schedule of Benefits (Benefit Package D, Network 1) These services are covered as indicated when authorized through your Primary Care Physician in your Participating Medical Group. (Only one hospital Copayment per admit is applicable. If a transfer to another facility is necessary, you are not re