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Get Restraint Consent Form

Ling process and injury to self. Voluntary or involuntary movements that may re-injure a treated condition. TYPE OF RESTRAINT: Soft Wrist Both Soft Ankle Both Mittens Waist Belt Four Side Rails Up Medical (Identify medication(s) to be given) Right Right Left Left ALTERNATIVES ATTEMPTED AND FAILED Verbal Intervention Reality Orientation Camouflaging Techniques Companionship Frequent Monitoring Relaxation Techniques Comfort Measures Other Based on an ex.

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