Patients
Johnny Appleseed
Patient Information
First Name*
Johnny
MRN*
12345678
Last Name*
Appleseed
Phone*
(617) 222-2222
Treating Oncologist
Andrea Enzinger
Last Report and Contact
Last report
Today, 11:42AM
Last RN Contact
4 days ago
Medications
Rx
Action
As Needed Pain Medicines
Oxycodone, 5 mg tablets
Take 1-2 tablets (5-10 mg) every 4 hours
Edit | Delete
Regularly Scheduled Pain Medicines
Morphine (MS Contin), 15 mg tablets
Take 1 tablet (15 mg) every 8 hours
Edit | Delete
Daily Constipation Medicines
Polyethylene glycol (Miralax), 17g capfuls
Take 1-2 capfuls mixed in liquid 2 times a day.
Edit | Delete
Senna (Senokot), 8.6mg tablets
Take 1-4 tablets by mouth 2 times a day.
Edit | Delete
Last med reconciliation
Sunday, May 1
Patient reports opioids are ACCURATE
No
Monday, May 3
Constipation Rescue Medicines
Glycerin Suppository
Insert 1 suppository into bottom for severe constipation.
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Add Medication
Update
Daily Pain Report
Today, 11:42AM
"In the past 24 hours, what was your pain at its.."
Worst pain
8
Average pain
5
Best pain
4
0 = No pain
10 = Worst pain imaginable
Is the pain acceptable?
No
Is the pain new?
No
Opioid Use
How well did it work?
Doses of short-acting opioid in last 24 hours
4
Red Flag Symptoms
Fever of 100.5 or greater;
Vomiting 2 or more times in the last 24 hours
Red flags
Pain Interference
"How much does pain interfere with..."
Activity
7
Sleep
5
Enjoyment of life
3
Pain
0 = no interference
10 = completely interferes
Bowel Habits
Today, 11:42AM
Constipation
Yes
Last BM
3 days ago
Severe symptoms
Vomiting two or more times
Diarrhea
No
Patient-Reported Laxative Use
Laxatives taken
Senna (Senokot®)
PEG (Miralax®)
Docusate (Colace ®)
Senna AM
2
tablets
Senna PM
2
tablets
Miralax AM
Miralax PM
0
capful
1
capful
App-Recommended Laxatives Changes
Small adjustment
Increase senna:
Take 4 tablets of senna in the morning, and 4 tablets in the evening.
Continue Miralax:
Also, keep taking your current dose of Miralax.
Proactive approach
Increase Senna:
Take 4 tablets of senna in the morning, and 4 tablets in the evening.
Increase Miralax:
Also, increase your Miralax, by dissolving 17g (one capful) of Miralax in 8oz of water, two times a day.
Mood
Today, 11:42AM
"To what extent have you felt the following in the last few hours..."
Nervous
4
Sad
5
Irritable
3
1 = very slightly/not at all
5 = extremely
Report History
Weekly Analgesic Use Report
3 days ago
Are pain medicines working well enough?
Yes
Opioid Side Effects
Fatigue
Dry mouth
Nausea
Short-Acting Opioid Use
# Doses per 24 hours
6
# times at
lower dose range
3
# times at
upper dose range
2
Long-Acting Opioid Use
OTC Pain Medicine Use
Taking as prescribed?
N/A - Medication inaccurate
Naproxen (Aleve)
Morphine (MS Contin), 15 mg tablets. Take 1 tablets (15 mg) every 8 hours.
Rx:
Oxycodone, 5 mg tablets. Take 1-2 tablets (5-10 mg) every 4 hours
Rx:
OTC taken in the past week:
# Doses outside Rx range
1