Blood transfusion paperwork
Client's blood unit label:
Blood Product Unit ID: 121212344
O
Melville ARC Center
Packed Racked red blood cells
RH Positive
CMV neg
American Blood services
This product may transmit
infectious diseases
Collected 2/10/2010
Expired
Container Manufactured by Pall
Inc.
5/10/2010
East Hills, New York
Client's transfusion record
Name
Gender
DOB
MR #
Transfusion Record
Physician
Admitting
date
Simpson, Meredith
F
4/23/1961
424353
Dr Ramirez
2/23/2010
Patient Information:
Patient: Name: Simpson, Meredith Location: 2E 1000-A
Patient ID: 424353
Date of Transfusion: 2/23/2010 Physician: Ramirez, T
Order Information:
Order number: 002683 Blood Product Unit ID: 121212344
Blood Product: Packed Red Blood Cells Attribute: IRR
Transfusion Priority: Routine Product Blood Type: O Positive
Release Date/Time: 2/23/2010 18:00
Transfusion status: Completed: _________________
Pre Transfusion Checklist:
Pre transfusion HGB checked:  yes History of Previous reaction: yes
History of previous transfusion:  yes  no
Risk factors reviewed  yes
Pre transfusion VS BP___ HR_______ RR_____ T______F
Premed: Given as ordered  yes Second RN order check  yes
second RN at bedside for ID  yes Verbal ID:  yes Arm band scanned:  yes Blood Group matched:  yes
Compatibility confirmed yes Product as ordered:  yes
Transfusion Activity:
User ID: SMT2 User name:____________, RN
Indication for Transfusion: anemia
Comment: Patient reaction - none
Second verification by: _______________2
Admin set/ Filter type: Leukocyte reduction filter (LRF)
Transfusion start date/time: 2/23/2010 18:20
Transfusion completed:
Time
Comments:
BP
HR
RR
Temp
Client assessment
Client's armband
Simpson, Meredith
424353
F
Dr Ramirez
4/23/1961
2/23/2010