Medical form

• US 5,188,563 A
• Filed: 08/03/1992
• Issued: 02/23/1993
• Est. Priority Date: 08/03/1992
• Status: Expired due to Term

• Current Assignee: Med-Pass, Inc. (Reynolds & Reynolds Company)
• Original Assignee: Med-Pass, Inc. (Reynolds & Reynolds Company)
• Inventors: Hanauer, Lisa E.
• Primary Examiner(s): Bell, Paul A.
• Application Number:
  US07/924,178
• Time in Patent Office: 204 Days
• Field of Search: 283/900, 462/56, 462/902
• US Class Current: 462/56
• CPC Class Codes: B41L 1/22 made up of single sheets or forms
• CPC Class Codes: B42D 15/0053 Forms specially designed for commercial use, e.g. bills, receipts, offer or order sheets, coupons
• CPC Class Codes: Y10S 283/90 Medical record
• CPC Class Codes: Y10S 462/902 Camouflage or nontransfer

Abstract

A combination medical form includes a Physician'"'"'s Orders Sheet, a Medication Administration Record and a Treatment Administration Record. The Medication Administration Record and the Treatment Administration Record feature non-overlapping columns of instruction blocks and a series of columns of record cells arranged in a space efficient manner.

Claims

1. A medical form comprising a Physician'"'"'s Orders Sheet, a Medication Administration Record, a Treatment Administration Record and pressure transfer means, all releasibly bound in mutual registration;

said Physician'"'"'s Orders Sheet being arranged on top of both of said records for direct entry of physician'"'"'s orders and having a front face which is printed to display a vertically extending column of medication instruction blocks for insertion of medication orders and a vertically extending column of treatment instruction blocks for insertion of treatment orders;

said Medication Administration Record having a front face which is printed to display a vertically extending column of medication instruction blocks in registration with the like-named blocks on said Physician'"'"'s Orders Sheet and a series of vertically extending columns of medication record cells, said columns of medication record cells and said column of medication instruction blocks having an aggregate horizontal width which is substantially equal to the full width of the front face of said Medication Administration Record;

said Treatment Administration Record having a front face which is printed to display a vertically extending column of treatment instruction blocks in registration with the like-named blocks on said Physician'"'"'s Orders Sheet and a series of vertically extending columns of treatment record cells, said columns of treatment record cells and said column of treatment instruction blocks having an aggregate width which is substantially equal to the full width of the front face of said Treatment Administration Record;

said columns of medication instruction blocks and said column of treatment instruction blocks being placed in non-overlapping areas of said form, and said columns of record cells being horizontally placed to occupy areas which are non-occupied by their associated instruction blocks;

said pressure transfer means being arranged for pressure actuated transfer of physician'"'"'s orders from the medication instruction blocks on said Physician'"'"'s Orders Sheet to the like-named blocks on said Medication Administration Record and pressure actuated transfer of physician'"'"'s orders from the treatment instruction blocks on said Physician'"'"'s Orders Sheet to the like-named blocks on said Treatment Administration Record; and

said pressure transfer means being further arranged to avoid pressure actuated transfer of markings onto any of said columns of medication record cells or any of said columns of treatment record cells.

2. A medical form according to claim 1 wherein said columns of medication instruction blocks are arranged toward the left of said form;

said columns of medication record cells are arranged to the right of said columns of medication record blocks;

said columns of treatment instruction blocks are arranged medially of said of said form; and

said columns of treatment record cells are arranged in two banks flanking said treatment instruction blocks to the left and to the right.

3. A medical form according to claim 2;

said Medication Administration Record having a rear face which is printed to display a plurality of data entry lines and instructions for recording medication administration notes thereon; and

said Treatment Instruction Record having a rear face which is printed to display a second plurality of data entry lines and instructions for recording treatment administration notes thereon.

4. A medical form according to claim 3, said pressure transfer means comprising reactive dyes carried within pressure responsive microcapsules.

5. A medical form comprising a Physician'"'"'s Orders Sheet, a Medication Administration Record, a Treatment Administration Record and pressure transfer means, all releasibly bound in mutual registration;

said Physician'"'"'s Orders Sheet being arranged on top of both of said records for direct entry of a physician'"'"'s orders and having a front face which is printed to display a vertically extending column of medication instruction blocks for insertion of medication orders and a vertically extending column of treatment instruction blocks for insertion of treatment orders;

said Medication Administration Record having a front face which is printed to display a vertically extending column of medication instruction blocks in registration with the like-named blocks on said Physician'"'"'s Orders Sheet and a series of vertically extending columns of medication record cells, said columns of medication record cells and said column of medication instruction blocks having an aggregate horizontal width which is substantially equal to the full width of the front face of said Medication Administration Record;

said Treatment Administration Record having a front face which is printed to display a vertically extending column of treatment instruction blocks in registration with the like-named blocks on said Physician'"'"'s Orders Sheet and a series of vertically extending columns of treatment record cells, said columns of treatment record cells and said column of treatment instruction blocks having an aggregate width which is substantially equal to the full width of the front face of said Treatment Administration Record;

one of said columns of instruction blocks being situated medially of its associated administration record and being flanked on both sides by banks of record cells;

the other said column of instruction blocks being situated to the left side of its associated administration record and to the left of its associated columns of record cells;

said pressure transfer means being arranged for pressure actuated transfer of physician'"'"'s orders from the medication instruction blocks on said Physician'"'"'s Orders Sheet to the like-named blocks on said Medication Administration Record and pressure actuated transfer of physician'"'"'s orders from the treatment instruction blocks on said Physician'"'"'s Orders Sheet to the like-named blocks on said Treatment Administration Record; and

said pressure transfer means being further arranged to avoid pressure actuated transfer of markings onto any of said columns of medication record cells or any of said columns of treatment record cells.

6. A medical form according to claim 5, said pressure transfer means comprising means for transferring selected instructions from said Physician'"'"'s Orders Sheet to the front face of the uppermost of said administration records and other selected instructions marklessly through said uppermost administration record and markingly upon the front face of the administration record situated therebelow.

7. A medical form comprising an original copy of a Physician'"'"'s Orders Sheet, a duplicate copy of said Physician'"'"'s Orders Sheet in registration below said original copy, a Medication Administration Record in registration below said duplicate copy, a patterned pressure transfer sheet in registration below said Medication Administration Record and a Treatment Administration Record in registration below said pressure transfer sheet;

said copies of said Physician'"'"'s Orders Sheet having front faces which are printed to display mutually registered and vertically extending columns of medication instruction blocks for insertion of medication orders and mutually registered, vertically extending columns of treatment instruction blocks for insertion of treatment orders;

said Medication Administration Record having a front face which is printed to display a vertically extending column of medication instruction blocks in registration with the like-named blocks on said copies of said Physician'"'"'s Orders Sheet and a series of vertically extending columns of medication record cells, said columns of medication record cells and said column of medication instruction blocks having an aggregate horizontal width which is substantially equal to the full width of the front face of said Medication Administration Record;

said Treatment Administration Record having a front face which is printed to display a vertically extending column of treatment instruction blocks in registration with the like-named blocks on said copies of said Physician'"'"'s Orders Sheet and a series of vertically extending columns of treatment record cells, said columns of treatment record cells and said column of treatment instruction blocks having an aggregate width which is substantially equal to the full width of the front face of said Treatment Administration Record;

said column of treatment instruction blocks being situated medially of said Treatment Administration Record and being flanked on both sides by banks of said treatment record cells;

said column of medication instruction blocks being situated to the left side of said Medication Administration Record and to the left of said medication record cells;

said pressure transfer sheet being arranged for pressure actuated transfer of physician'"'"'s orders from the treatment instruction blocks on said copies of said Physician'"'"'s Orders Sheet, marklessly through said Medication Administration Record and markingly into the like-named blocks on said Treatment Administration Record; and

pressure actuated means being provided for transferring physician'"'"'s orders from the medication instruction blocks on said copies of said Physician'"'"'s Orders Sheet to the like-named blocks on said Medication Administration Record.