Visiting Nurse Reports for Former President Harry S. Truman

VNA copy 04 Confidential PLEASE CHECK INITIAL REFERRAL copy bas MISSOURI - KANSAS METROPOLITAN PROGRESS NOTES Inter-Agency Referral Form RENEWAL Patient Truman, Harry S. VISITING NURSE ASSN. Hosp. # From OF GREATERIRANSAS CITY Birth Date 5-8-84 Sex M S M W D Sep. Medicare # 4128 BROADWAY Address: Apt. # Floor. OPD # Address KANSAS CITY, MO. 64111 219 Delaware 117 S.S. # Tele. No. PHONE JE. 1-1200 (DIRECTIONS) STREET C.T. Unit Independence Jackson 64050 CL 2-7107 CITY COUNTY ZIP CODE TEL. NO. To Wallace Graham, M.D. AGENCY Responsible Person Relationship Address 1815 E. 63rd Hosp. Adm. Date Disch. Date Kansas City, Mo. Next app't date In clinic (name) Date of Referral DIAGNOSIS AND PROGNOSIS: Proctitis Fecal Impaction Has Tuberculosis been ruled out Yes No X-Ray TB Tests Other Communicable Disease ? Allergies ? Has Diagnosis & Prognosis been told patient ? Family ? PHYSICIAN'S RECOMMENDATIONS AND PLAN OF RX must include instructions for care; treatment; diet; activities; name of medication; dosage; method and frequency; supplies and Treatment: appliances needed. ) Fleets enema or S.S. enema to remove impaction Insert Cucolax Suppository prn for bowel regulation Medication: MI SEHTO STO HTJASH OLIEUS Pericolase ii H.S. Diet: Regular Activity: Not restricted MENCAL SOCUAL WORKER MAY PRONIDE SERVICES AT DISCRETION OF PROFESSIONAL - YES AMDE MIT DE ASSIGNED AT DISCRETION OF PROFESSIONAL NURSE, YES NO I hereby certify this person for home health services: Date 6/28/69 Signature Specialty Tele. # & Ext. REPORT OF DIETITIAN, MEDICAL SOCIAL WORKER, PHYSICAL THERAPIST, OCCUPATION THERAPIST, ETC. Date Signature Specialty Tele. # & Ext WHITE-RECEIVING AGENCY PINK-RECEIVING AGENCY YELLOW-ORIGINATING AGENCY FILE COPY PHNC 9-67