Free Reply Brief - District Court of Delaware - Delaware

Case 1:04-cv-01542—GI\/IS Document 36-2 Filed 08/12/2 Flager1 of 1
M ' .` COR} `IONAL
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Du, .;:1. 1 rF#J___ __ Date Renewed: _
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On $1::4.%-4.11:1111-, _ __ Yes No Last Medication Given at
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yp;. — 4 ALLOWED DENIED
i 1/ eindergarments Legal Materials:
*1/- —.uicidal Blanket Rationale:
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__ 1/ Srnoking Materials 5
TIME VISUAL CHECKS MADE ON PATIENT
("'fiil1` iXP NATION 12 a.m.- 8a.m. 8 a.m.—4 .m. 4 .m.-12 .m.
1 . :» —...1411.:.11 0:00 d. 4:00 {12 1/ pk
:4 12:15 0 4:15 0 14
Q- 4 12:30 { - 8:30 • Z 4:30 1 / -
4 *`l1fY€11lg_ 12:45 (Q - 3:45 ` %
' 4*% Nanxghing 1:00 [(/*1*] - 9:00 · A 5:00 ;{ in
+4:1:100. N5 111 [
tduriniilirag incohcrenlly 1:30 ° / - 9:30 ' · 5:301 1 . '
1- ¤5141·0:01151·11 5:45 1
9 Walking 2:00 Q 1 -10:00 10 ,» 1 6.00 , -
1- 1 01111; :11 sming 10:15 _ ; 6:15 jg ig -
1. €_F\1lt;l 2:30 0 ; _ - 6:304p 1 -
14. 01040141 15:451 1. 1
13. Meals served/eaten 3:00 ~ 7:00 9 ll -
_14. F'1uidsScwed/taken 3:15 . 11:15 , 7:15 11/ -
15 Esaihfshiawer 3:30 K { -11:30 5 , '. 7:30 1) 1 -
111. lilllltfli 3:45 - _ ‘ 11:45 - :1:45 -
1'/.51moki11 4:00 O i f ’ 12:00 ` 8:00 0 r -
10 Talking . .. 4:15 155 · 0:151~ UI 1
10. .. ‘ ' ' .111 .,,,,, ’ L,. 4:20 .*0 _ 12:30 · .. 8:20..1 1 -
s1a1·1s1 ..111. .. Initials 4:45 10 1 : 8:4510 ll -
5:00 1U 1 1 0:004.: 1 1
1:15 .1 I, 0:151.. . ·
1.. - _» 1:50 A 0 0:50 1. ll 1
_ . .-._.,.. 5:45 IU 0:45 4 .1 1
_ __ -_..... -· -. " *1 5:00 0 1 10:00 1. .1 1
. .- . - . .- 5:15 110 :1 1 101510 .1 1
‘f’1404¤ry`11hee5=;1¤·;=1_.-.-.__m 600 0 ll 1 2:30 ‘ · · Q 10:30 0 11 -
- ___ 6:45 r1 / 10:45 - -
. .. .... _. 1.00 / 1 EEBH1K
4 5 ........:.1:.·1.....1.»1..4.__ _ 7:l5 0 11 *1*5 10 11 I
_ _ __ 7:30 :0: ,1/ 1 3:30 ‘4 , 11:3010 gl
[ 1 1 1:45 6 1 H 5:45 4 4 , I ai3
Code and Signature are required on the above time lines per precaution level
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