Template to prepare for Peer to Peer review

[ Name ],[ Age ] [ Gender ]-[ Assigned Facility ]** [ Assigned Room ]-[ Assigned Bed ]** [ Body Mass Index ];
PMH: [ Diagnosis ], _

1:[ Arrival Date and Time ], Admit@_
2: _
3: _
4: _
5: _
6: _
7: _
8: _
9: _
10: _
:[ Discharge Date and Time ]: Discharged to [ Discharge Disposition ]. LOS: [ Encounter LOS ]