Admission Assessment

Comprehensive admission documentation with history, functional baseline, and orientation.

For educational use only. Always verify with clinical judgment and facility protocols.

Admission Assessment

Comprehensive admission documentation template.

Admission Details

Date/Time

Admitting Diagnosis

Admit From

Provider

History

Allergies

Home Medications

Past Medical History

Past Surgical History

Functional Baseline

Mobility Prior

ADL Independence

Living Situation

Fall Risk

Morse Score

Risk Level

Skin Assessment

Braden Score

Existing Wounds

Pressure Injuries on Admission

Baseline Assessment

Vitals

Pain Score

Code Status

Advance Directives

Has AD on fileOffered AD information

Orientation Provided

Call lightBed controlsBathroomVisiting hoursFall precautionsNurse call system

Belongings

Valuables secured

Belongings List

Live Preview

ADMISSION ASSESSMENT ADMISSION: [Date/Time]. Diagnosis: [Diagnosis]. Admitted from ED. Provider: [Provider]. HISTORY: Allergies: [Allergies]. Home meds: [Home medications]. PMH: [PMH]. Surgical hx: [Surgical history]. FUNCTIONAL: Mobility: Independent. ADLs: Independent. Living: Home alone. FALL RISK: Morse score [Score], Low 0-24. SKIN: Braden [Score]. BASELINE: Vitals: [Vitals]. Pain: 0/10. Code status: Full Code. ADVANCE DIRECTIVES: No AD on file. AD information not yet offered. ORIENTATION: [None documented]. BELONGINGS: Valuables not secured. [Belongings list].

Tip: Customize the template using the options on the left. The signature [NursingWorksheets.com] is added automatically when you copy.