ࡱ> 7963 bjbjCC ".!!l:::::::NJ J J 8 N5  (F F F F F F $  :F F F F F ::F F F d:F :F F X::XF  d SN J dXX\05X XNN::::Patient Belongings Inventory1. Incident Name:2. Date prepared:3. Time prepared:4. Operational period date/time:5. Patient InformationTracking #:patient Name:Gender: M/FDate of Birth:Date of Death:6. Items:6. disposition location:Location Address:Location Phone Number:7. Prepared By:8. Approved By:9. Facility Name10. INDIVIDUAL CLAIMING ITEMS:RELATIONSHIP TO PATIENT:DATE OF RECEIPT OF ITEMS:SIGNATURE: First letter of decedents LAST name _______ Page  PAGE 1 of  NUMPAGES 1 ORIGINATOR: PATIENT TAGGERS (during Patient Surge) or MORGUE UNIT PURPOSE: To track personal belongings of patients. COPIES TO: Attach one to patients personal belongings bag, one to Decedent Tracking Form, copy to Documentation Unit Leader, copy to next of kin signing inventory log. October 2008 78>?@AEFPQRSTWbν۱۱5CJOJQJ\^JCJCJOJQJ^JmHnHujCJOJQJU^JCJOJQJ^JCJOJQJ^J;CJOJQJ^J;OJQJ^J01L$f$$Ifl#H$  0H$64 la$Iff$$Ifl#H$  0H$64 la $$Ifa$1CUvwv`$$IflFu #  ] 0H$6    4 la$Ifl$Iff$$Ifl#H$  0H$64 la$Ifp$$Ifl0u # g0H$64 la|,v$If$$IflFu #  ] 0H$6    4 la66]$$Ifl#H$0H$64 la$Iff$$Ifl#H$  0H$64 la$If]$$Ifl#H$0H$64 la $If]$$Ifl#H$0H$64 la     $If]$$Ifl#H$0H$64 la !"#$%$If]$$Ifl#H$0H$64 la %&?@Rih6f$$Ifl#H$  0H$64 la$If]$$Ifl#H$0H$64 laijz$Ifp$$Ifl0#L0H$64 laHz]$$Ifl#H$0H$64 la$If$$Ifl0#L 0H$64 laf$$Ifl#H$  0H$64 la$If0.,]$$Ifl#H$0H$64 la$Ifm$$Ifl0#L0H$64 laTUVWu$ !#]a$ $ !#]a$$a$  !t"#] 1h/ =!"#$% i8@8 NormalCJ_HaJmH sH tH 6@6 Heading 1$@& 5CJ \<A@< Default Paragraph Font,@, Header  !, @, Footer  !.01CUvw      !"#$%&?@RijzTUWu0000000000000000000@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0000000000000000000000000@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@000000000000@0@0@0000000@0@0@0@0@0@0@0@0 0WY1 %i 9@BGRT!tt7AESUW7AESUW/001BCTUuvvw!!##$>??@yz7AEScpurintoT:\Operations and Planning\Planning\Local Planning\Hospital Planning\Hospital EOP\Annexes\AnnexL_Forms\Forms_Word\Patient Belongings Inventory.doccpurintoT:\Operations and Planning\Planning\Local Planning\Hospital Planning\Hospital EOP\Annexes\AnnexL_Forms\Forms\Patient Belongings Inventory.doccpurintoT:\Operations and Planning\Planning\Local Planning\Hospital Planning\Hospital EOP\Annexes\AnnexL_Forms\Forms\Patient Belongings Inventory.doc01CUvw      !"#$%&?@Rijz@ (z@UnknownGz Times New Roman5Symbol3& z Arial"1hSfkf I!0d2QPatient Belongings InventorycpurintocpurintoOh+'0 ( D P \hpxPatient Belongings InventoryMiati cpurintoelopurpurNormalo cpurintoelo10rMicrosoft Word 9.0I@ @̣}@rLSI՜.+,0 hp  KDHE  Patient Belongings Inventory Title  !"#$%'()*+,-/0123458Root Entry FS:1TableWordDocument".SummaryInformation(&DocumentSummaryInformation8.CompObjjObjectPoolSS  FMicrosoft Word Document MSWordDocWord.Document.89q