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Get NHICS 260 2011-2021

SICIAN: 9. FACILITY NOTIFIED: YES NO CONTACT INFORMATION: 10. ACCOMPANYING EQUIPMENT (CHECK THOSE THAT APPLY): HOSPITAL BED GURNEY WHEEL CHAIR AMBULATORY SPECIAL MATTRESS ISOLATION: IV PUMPS OXYGEN VENTILATOR BLOOD GLUCOSE MONITOR RESPIRATORY EQUIPMENT YES NO ID BAND CONFIRMED: FOLEY CATHETER OTHER OTHER OTHER OTHER TYPE: 11. DEPARTMENT LOCATION ROOM#: SERVICE ANIMAL G TUBE PUMP MONITOR OTHER OTHER 12. ARRIVING LOCATION TIME: YES ROOM#: NO ID BAND CONFIRMED BY: TIME: ID BAND CON.

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