Dickinson college student health services
Dickinson
College
Student
Health
Services
UTI/GU
Name ____________________________________________Class_________Date ____/____/____
S: cc:_____________________________________________________________________________________
Symptoms yes no duration / location / character
Additional Hx. _________________________________________________________________________________________
______________________________________________________________________________________________________
PMH
Current meds? _____________________________________________________________________________________
Med. allergies?
_______________________________________________________________________________________
O: temp___
Dickinson College Student Health Services
UTI/GU (pg 2)
Name ________________________________________________________________________________ Class__________
LABS:
Dipstix
Micro
KOH/WP
Pyelonephritis Other ____________________________________________
Bactrim DS 1 po BID X 3 days / 10 days
Amoxicillin 250 mg 1 po TID X 10 days
Cephalexin (Keflex) 250mg QID / 500 mg BID X 10 days
Referral ______________________________________________________________________________
LABS REFERRED: None UA Culture Pap Chlamydia Herpes GC
Patient Discharge Instructions Given
Health Education Warned of possible effects of antibiotics on oral contraceptives
Instructions: inc.fluids, void p intercourse, hygiene, UTI handout
RTC __________________________ RTC PRN
_____________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ \FORM\uti.cck
Source: https://webmail.dickinson.edu/departments/health/Clinical-Checksheets/UTI-CCK.pdf
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Submitted by: Charles Bantz, Provost and Senior Vice President Academic Affairs JOSEPH F. YOUNG, SR. PSYCHIATRIC RESEARCH AND TRAINING PROGRAM PROPOSED BUDGET FISCAL YEAR 2003 It is recommended that the Board of Governors approve the proposed FY 2003 budget for theJoseph F. Young, Sr. Psychiatric Research and Training Program to be allocated to program Approved Proposed Progr