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Get FL AHCA 5000-3008 2015

02: 2 3. date inserted: Foley Catheter: Yes No If yes, date inserted: Indications for use: Urinary retention due to: Monitoring intake and output Skin Condition: Other: Attempt to remove catheter made in hospital? Date Removed: Bowel: Continent Incontinent Ostomy List any other lesions or wounds: Yes U. MENTAL / COGNITIVE STATUS AT TRANSFER Alert, oriented, follows instructions Alert, disoriented, but can follow simple instructions No Alert, disoriented, and cannot follow simple instructio.

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