Outpatient Dialysis Orders


Date:
From:

Patient Name:
Date of Birth:

Resume previous outpatient dialysis orders without change except for the following exceptions:

None



While the patient was in the hospital, we dialyzed with the following orders:

Dialysis Schedule: Mon/Wed/Fri Tue/Thur/Sat
Duration: hours minutes
Dry Weight:
Dialysis Bath:
Ca:2.5 Potassium: Bicarb: Sodium:
Heparin:None