Activities of Daily Living Checklist

Name*

Work Email*

Work Phone*

Facility Name*

Board Options (check all that apply):

Activity Notes / Today's Plan
Allergies
Best Care for Me
Care team Information
Daily Goals
Day / Date
Diet Plan / Menu Restrictions
Discharge Date
DNR / Organ Donor / 5 Wish List
Family Contact Information
Helpful Contact Numbers
Hourly Rounding Grid
Icons, Illustrations, or Photos
I/O, NPO, Tube Feeder
Labs / X-Rays / IV
Logo Banner (Current Marketing Branding)
Medication Dosage Chart
Mobility / Safety Risks
Nicotine Patch Request
Nursing Director / Case Manager
Pain Scale / Pain Goal / Pain Plan
Palliative Care Plan
PCA / Tech / Assistant
Physician Grid
Please Call Don't Fall
Post Discharge Plan
Preferred Language
Prosthetic / Eyeglasses / Bridgework / Hearing Aid
Room # and Phone #
Rounding Acronym (5 Ps, etc.)
Slogan or Hospital Directive
Spiritual Counseling Contact
Therapy; OT/PT/RT/ST
Translations
Transportation Plan
Vitals (ED Boards)

Other Board Options:

Please send me a quote for these size(s):

20in x 24in image (outside dimensions 21.25in x 25.25in)
22in x 28in image (outside dimensions 23.25in x 29.25in)
24in x 30in image (outside dimensions 25.25in x 31.25in)
24in x 36in image (outside dimensions 25.25in x 37.25in)
30in x 40in image (outside dimensions 31.25in x 41.25in)

Interested in Multiple Department Layouts/Entire hospital?

General Population
Critical Care Unit
Antepartum
Labor & Delivery
Mother & Baby Unit
NICU
Pediatrics
Emergency Department
Medical Surgery Unit
Rehabilitation Services
Cardiology
Orthopedics
Neurology

Other:

Total boards for the entire Hospital:

Interested in Volume pricing for Multiple Hospitals? Total number of Hospital locations:

Total number of boards for all locations:

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