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Get Emergency Medicine Patient Safety Foundation Safer Sign Out Form

________ Problem List & Key Issues Diagnosis/CC: Pending Items Disposition Home___________ Room Key Issues: Admit___________ Date Shift Started___________ Receiving Clinician’s Notes Rounded on Patient Included/Informed Nurse Transfer_________ NH_____________ TBD____________ Potential Safety Issues or Precautions? Diagnosis/CC: Home___________ Room Key Issues: Admit___________ Rounded on Patient Included/Informed Nurse Transfer_________ NH_____________ TBD____________ Potential.

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