Page 30 - CLINICAL PRACTICE II
P. 30
CikguOnline
CikguOnline
TOTAL SCORE Total score of 12 or less represents
HIGH RISK
D
EVALUATOR A EVALUATOR
ASSESS DATE SIGNATURE / ASSESS
TITLE T SIGNATURE /
E TITLE
1 / / 3 / /
2 / / 4 / /
R
Attending
NAME-Last First Middle e Room/Bed
Physician
c
or
d
N
o.
30 | P a g e
