Get Baptist Hospital of Miami Form 496 2006
4 and MgS04 DATE DOCTOR’S ORDER SHEET TIME Use black ball point pen. RM# Reminder: Date, time all orders. Print name & ID # under signature. ONE SET OF ORDERS PER PAGE / MARK THROUGH BLANK LINES / SCAN ALL ORDERS Physician’s Signature _________________________________ AND Print Name ________________________ I.D. #: ____________ SCANNED DATE: _______ TIME: _______ INITIALS: _______ *07600BF496* Form # 496 Rev. 11/06 07600BF496 .
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