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Updated Med Surg Admission Form

Updated Medical-Surgical Pre-Printed Admission Form Now Available

The Medical-Surgical Pre-Printed Admission Order Form has recently been updated and is now available. Click here for a PDF version of the order form (Form 8846 Version 16).

The pre-printed admission forms were slightly modified to help the medical center determine which physician is responsible for a patient's History and Physical (see addendum to Question #3 on the updated form).

As a reminder, the following procedure has been implemented to facilitate medical/surgical admission orders in the event that Telephone Orders are required for admission. In addition to improving efficiency, this procedure helps physicians remember important interventions to improve patient care and decrease variation. In addition, the procedure will help decrease the number of calls physicians receive for clarification of orders or inadvertently omitting orders (e.g., laxatives, pain medication).


  • For physicians who must create admission orders and who are not on campus, and cannot reasonably FAX orders, Telephone Orders should be phoned to the area where the patient is located.
  • For patients who do not have bed assignments, Telephone Orders should be phoned to the Nursing Office at ext. 3-5181.
  • The RN receiving orders will "read through" the Medical-Surgical Pre-Printed Order Form (Form 8846).
  • The admitting physician will give orders to complete the Medical-Surgical Pre-Printed Order Form over the telephone.
  • When the RN and MD have completed this form, the RN will then "read back" the orders for confirmation.
  • These orders will be delivered to the patient's care area for initiation of these orders ASAP.
  • These orders will then reside on the chart for signature by the admitting physician in the AM. (These would be the only Telephone Orders not signed electronically.)