Drip irrigation emitter clogging in Dutch
Drip irrigation emitter clogging in Dutch
greenhouses as affected by methane
and organic acids
C.de Kreij *,A.M.M.van der Burg,W.T.Runia
Division of Glasshouse Horticulture,Applied Plant Research,P .O.Box 8,2670AA Naaldwijk,The Netherlands
Accepted 28October 2002
Abstract
It is believed that the serious clogging of drip irrigation emitters in the Dutch greenhouse industry is
caused by methane-oxidising bacteria and/or organic acids used as anti-clogging agents.In this study
greenhouses with moderate to severe emitter clogging have been examined.High methane concentra-
tions—up to 69mg/l—were found both in ground water (GW)and in the water from reverse osmosis
(RO);however,in the fertiliser-mixing tanks (MTs),methane concentrations were <0.01to 9mg/l.
In trials,a methane concentration of 0.11mg/l in the fertiliser-mixing tank (MT),giving 0.08mg/l
at the emitter outlet,caused severe clogging of tube emitters and after prolonged exposure,also of
labyrinth emitters.Slime in the emitter with ‘methane treatment’contaminated not only higher
carbon and adenosine triphosphate,but also higher element concentrations than in the non-methane
treatment.Biofouling increased the deposits of salts (scaling).To avoid emitter clogging,growers
using ground water should carefully volatise the methane gas if it is present in the fertiliser-mixing
tanks at concentrations higher than 0.01mg/l,i.e.the detection limit.
Organic acids,i.e.acetic acid and formic acid,were shown to increase the growth of Trichoderma ,
a fungus often isolated from emitter https://www.wendangku.net/doc/d43673201.html,mercial anti-clogging agents containing organic acids
were not effective in killing Trichoderma .It is likely that the carbon of the acids serve as a substrate
for the micro-organisms.The use of anti-clogging agents without organic acids is advisable.
#2002Elsevier Science B.V .All rights reserved.
Keywords:Clogging;Drip irrigation;Methane;Organic acids;Trichoderma
1.Introduction
Clogging of drip irrigation emitters in the Dutch greenhouse industry has been
associated with various factors,e.g.solids,iron,calcium,phosphate,sulphate,
algae,
Agricultural Water Management 60(2003)73–85
*
Corresponding author.Tel.:t31-174-636729;fax:t31-174-636835.
E-mail address:Cees.dekreij@wur.nl (C.de Kreij).
0378-3774/02/$–see front matter #2002Elsevier Science B.V .All rights reserved.
PII:S 0378-3774(02)00159-2
74 C.de Kreij et al./Agricultural Water Management60(2003)73–85
hydrogen sulphide-oxidising bacteria,etc.(Abbott,1985;Gilbert and Ford,1986;Boman and Ontermaa,1994;Nakayama and Bucks,1991).In one case,the problem was related to silicon(Si)of ground water(GW)causing growth in the emitters of rectangular siliceous algae,Fragilaria(van der Burg,1999).However,in some Dutch greenhouses,where emitter visual and microscopic examination showed grey/white slime formation,the above men-tioned factors were not the cause.Growers with these severe clogging problems used ground water,often processed by reverse osmosis(RO),where hydrogen sulphide could be a serious factor(Walton,1993;Sagi et al.,1995;Ford,1976).Although,the smell of this gas was sometimes detected,water analysis showed hydrogen sulphide concentrations of<0.05mg/l, which is lower than the0.05–0.5mg/l level which causes problems(Abbott,1985;Bucks et al.,1979;Nakayama and Bucks,1991).Ground water often contains methane(Reijnen, 1994)and in drinking water tubes methane concentrations of3–20mg/l have resulted in bio?lm formation(Reijnen,1994).Methane can also stimulate rapid bacterial growth in open water tanks of ground water processed by reverse osmosis(Bernadette,2000).Methane is not held by reverse osmosis as it is a small molecule without water mantle as polar cations and anions.The diameter of0.38nm is smaller than the pores of the membrane of the reverse osmosis(1–2nm;Mulder,1991).Growers have tried to volatilise the gas.It was assumed that methane-oxidising bacteria were the causative factor in emitter clogging.
Laminar?ow of the tube emitter system results in more problems with clogging than the turbulent?ow of the labyrinth system(Abbott,1985).
Effective preventive measures,i.e.properly executed chlorination(Parchomchuk,1980; Rav-Acha et al.,1995)and/or acidi?cation are dangerous to use in rockwool cultivation systems because the nutrient solution is dripped in the vicinity of active roots.Also,the root volume is very limited compared to soil grown systems and unwanted high concentrations of chlorine could be toxic.The recommended free chlorine concentration of0.5–2.0mg/l at the outlet(Smajstrla et al.,1983;Sagi et al.,1995;English,1985)caused toxicity to tomato(van der Burg,1993).Also strong acids are dangerous to plant roots and they also dissolve the rockwool growing medium.Therefore,other preventives are being used,e.g.polyphosphates instead of ortho-phosphates(against precipitation of calcium phosphate),hydrogen peroxide and(weak)organic acids.However,severe clogging have been found in emitters from growers using organic acids as preventives(van der Burg,1996).The fungus Trichoderma has often been isolated and it was assumed that the organic acids promote Trichoderma growth. The aim of the study was(a)to examine methane concentrations in ground water of growers with severe clogging,(b)to determine the effect of methane on clogging of both tube and labyrinth emitters and(c)determine the effect of organic acids and commercial anti-clogging products on Trichoderma.
2.Materials and methods
2.1.Ground water,reverse osmosis and volatilisation
Water samples were taken in August1997from14growers with intermediate to severe emitter slime clogging de?ned as low emitter discharge and high variation of the discharge. Samples were gathered very carefully(to avoid volatilisation)from ground water prior to
C.de Kreij et al./Agricultural Water Management60(2003)73–8575 reverse osmosis,from water after reverse osmosis and from fertiliser-mixing tanks.To sample the ground water,special small taps(inner diameter5mm)were installed on the tubes after the pump.During pumping,the taps were opened and a?exible Te?on tube was inserted into the bottom of the collection bottles.The100ml-bottles were?lled with60ml of water. Bottles were sealed with rubber stoppers and put upside down in the collection box.Fertiliser-mixing tanks were sampled by?lling the bottles with a siphon.Bottles were chilled immediately at48C and methane was analysed within2days.In the laboratory,bottles were shaken for30min;gas from the bottles was sampled and methane was analysed using gas chromatography(GC)with ionisation detector.The detection limit was0.01mg/l water. In order to volatise the methane,growers1,4and8installed a large open collection tank and sprayed the reverse osmosis product water into the tank(spray collection tank(SCT)). From this tank,water was pumped to the fertiliser-mixing tanks.Methane concentrations were determined after each of these installations.Sampling was carried out on several dates during1998and1999.
2.2.Effect of methane on emitter discharge rate and variation
In a greenhouse trial at the Applied Plant Research Station,rain water was used to make a standard nutrient solution used for tomato as follows:EC?2:6mS/cm(258C);pH5.5 and(in mM):NH4,1.2;K,9.6;Ca,5.4;Mg,2.4;NO3,16.0;SO4,4.4;H2PO4,1.5and(in m M):Fe(as DTPA),15;Mn,10;Zn,5;B,30;Cu,0.75and Mo,0.5.Two fertiliser-mixing tanks of400l were?lled for irrigation of the two systems:
‘àMethane’:no additional methane.
‘tMethane’:bubbling pure methane at a constant rate in the tank.
Two types of emitters were used:
Tube system(‘French capillary’,inner diameter of the tube0.8mm;length80cm); specification:discharge of2l/h at a working pressure of80kPa.
Labyrinth system(on-line non-pressure compensating Netafim Woodpecker1),speci-fication:discharge of2l/h at the working pressure of100kPa.
Both tanks were inoculated with emitter slime from one of the growers with methane in the groundwater and emitter clogging.The emitters dripped the nutrient solution on rockwool slabs in gullies and the drain water was recirculated into the fertiliser-mixing tanks.Irrigation frequency was30times per day for2min with a working pressure of 100kPa.The drip system,rockwool slabs and gullies were under black/white polyethylene sheet in a greenhouse with an air target temperature of208C day and night.A130m m?lter was installed in the tube directly after the pump;the?lters were cleaned every4weeks. Methane oxidising bacteria consume NH4,therefore,the tank was dosed fortnightly with concentrated NH4NO3to give a NH4supply of0.2mM.EC,pH and water level in both tanks were controlled weekly to keep the EC at2.6mS/cm and pH at5.8by adding rain water,fertiliser,concentrated HNO3or a mixture of Ca(OH)2/KHCO3solutions.Element concentrations of the tanks were measured every2months to keep the target values.Water from the tanks was also analysed for methane by GC and adenosine triphosphate(ATP)by bioluminescence with a Lumac biocounter M2500according to Stan?eld and Jago(1988).
76 C.de Kreij et al./Agricultural Water Management60(2003)73–85
Regularly,two emitters of each treatment were collected and cleaned outside with96% alcohol.The tube system was cut longitudinally in two parts and the labyrinth emitter has been opened to reach the polypropylene inserted‘inner-disc’(diameter:12mm and thickness:3mm)containing the labyrinth.These parts were then:
Boiled in50ml0.2M H2SO4in a closed system.Total organic carbon(TOC)of the extract was analysed by combustion using a Skalar analyser(Houba et al.,2000).
Boiled in2.0M HNO3/0.5M HCl in a closed system for determination of Mg,P,S,Ca, Mn,Fe,Si and Al by ICP-AES.
Treated in an ultrasonic bath at41kHz(Branson5510)in a closed system.ATP was determined by bioluminescence.
TOC and element concentrations in the extracts was converted to TOC and element concentrations per unit length of the tube emitter and per unit‘inner-disc’of the labyrinth system.Data only can be compared within a certain type of emitter.Emitters were also examined visually and under the microscope.
The?rst experiment(series1)started on14July1998and ended on8May2000.The second experiment(series2)was a replication of the?rst and started on24June1999and ended on8May2000.In both series the same equipment and greenhouse was used. Emitter discharge of20(marked)emitters per treatment were measured every4weeks at a working pressure of100kPa and discharge means and coef?cient of variation was calculated.According to Capra and Scicolone(1998),this should provide an accurate insight into the distribution.
2.3.Effect of acids and commercial products on Trichoderma
Organic matter from clogged emitters from glasshouse growers using commercial anti-clogging products containing organic acids were collected.Trichoderma fungi were isolated and identi?ed as Trichoderma atroviride and Trichoderma virens.Isolates were cultivated on potato-dextrose–agar.Since recirculation of drain water is compulsory in The Netherlands,the effects of the anti-clogging agents were tested in drain water in comparison to demineralised water.Trichoderma(0.1ml suspension)was added to(a) demineralised water(1l)together with30m M Fe-DTPA fertiliser and(b)drain water(1l) of rockwool from a tomato grower without additional fertiliser.To these solutions,two different acids and commercial products A–E were added.The tested concentrations of the commercial products are based on the product itself(not on the active ingredients).For commercial products the trade names,speci?cations and recommended dose under practical conditions are given.Treatments are:
Acetic acid:0,1,2,4,8mg/l.
Formic acid:0,10,20,40,80mg/l.
A:0,25,50,100,200,500mg/l.(DegAzur2751;composition:H2O2(33%)tacetic acidtperacetic acid;recommended dose20–50mg/l).
B:0,30,70,100,200,500mg/l.(PerAzur4701;composition:H2O2(50%)tacetic acidtperacetic acid;recommended dose30mg/l).
C.de Kreij et al./Agricultural Water Management60(2003)73–8577 C:0,25,50,100,200,500mg/l.(Aldo1;composition:H2O2(35%);recommended dose 200mg/l).
D:0,10,50,100,200,500mg/l.(Horticlean1;composition:H2O2(35%)tacetic acid (8%)tperacetic acid(2.5%);recommended dose:day,10and night,50–100mg/l). E:0,25,50,125,175,500mg/l.(Reciclean1;composition:H2O2(20%)tformic acid (15%)tperformic acid;recommended dose125–175mg/l).
After1day,the mixtures were plated out on a selective medium(TSM)and the number of colonies was determined after7days.All treatments were in duplicate.Ef?cacy (mortality)has been calculated from the two plates,relative to the control,i.e.Trichoderma on the selective medium without organic acids or commercial products.
3.Results
3.1.Ground water,reverse osmosis and volatilisation
Methane concentrations in14growing facilities are given in Table1.Both groundwater and water from reverse osmosis contained far higher concentrations than water in the Table1
Methane concentrations in groundwater(GW),after reverse osmosis(RO),and in fertiliser-mixing tank(MT)of grower1–14
Methane concentration(mg/l)of grower no.1–14
1234567891011121314 GW28.015.019.036.051.026.031.069.0 6.432.00.4 4.80.97nd RO44.0nd11.032.028.025.032.044.0 6.342.00.4nd nd nd MT 2.1 1.04 1.209.40.0440.330.280.67.078.019nd<0.010.0120.83
nd:not determined.
Table2
Methane concentration in ground water(GW),water after reverse osmosis(RO),after spraying into a spray collection tank(SCT),and in the fertiliser-mixing tank(MT)of grower1,4and8
Methane concentration(mg/l)
Grower1Grower4Grower8
Mean S.E.n Mean S.E.n Mean S.E.n GW45.49.6729.0 1.7365.0 4.84 RO45.6 4.6731.1 1.4466.0 5.54 SCT0.36a0.76a120.690.5070.140.169 MT0.27b0.59b120.640.3270.100.047
S.E.:standard error;n:number of values.
a Three values with methane concentration below the detection limit(<0.01mg/l);calculated mean of these data set at the detection limit.
b Four values with concentration below the detection limit.
fertiliser-mixing tank.The effect of the installed volatilisation equipment of growers 1,4
and 8is shown in Table 2.The concentrations in the fertiliser-mixing tanks decreased
signi ?cantly,but,methane could still be detected.
3.2.Effect of methane on discharge rate and variation of emitters
Methane in the tank was <0.01(n ?7)and 0.11(?0.16;n ?5)for the ‘àmethane ’and
‘tmethane ’treatments,respectively.The methane concentration in the water discharged
from the emitters was <0.01(n ?5)and 0.083(?0.086;n ?5)mg/l for ‘àmethane ’
and
Fig.1.Emitter discharge and coefficient of variation in series 1of tube and labyrinth emitter at ‘àmethane ’and
tmethane ’.
78 C.de Kreij et al./Agricultural Water Management 60(2003)73–85
‘tmethane ’,respectively.ATP in the tank was 40(?40;n ?3)and 163(?38;n ?3)ng/l
for ‘àmethane ’and ‘tmethane ’,respectively.
The emitter discharge and coef ?cient of variation for series 1and series 2are given in
Figs.1and 2,respectively.In both series,the tube emitter discharge of treatment ‘tmethane ’
diminished by a factor $3between start and end while the coef ?cient of variation increased
signi ?cantly.The labyrinth emitter discharge rate in series 1was not affected by methane.
However,between days 300and 400the coef ?cient of variation increased in the ‘tmethane ’
but not in the ‘àmethane ’treatment.In series 2,the labyrinth emitter discharge rate and
coef ?cient of variation decreased and increased,respectively,after day
200.
Fig.2.Emitter discharge and coefficient of variation in series 2of tube and labyrinth emitter at ‘àmethane ’and
tmethane ’.
C.de Kreij et al./Agricultural Water Management 60(2003)73–8579
Table3
TOC,ATP and element concentrations of new(never-used)and of emitters at the end of series2of‘àmethane’and‘tmethane’treatment TOC ATP Ca Mg P
tube (mg/cm)lab.
(mg/lab.)
tube
(pg/cm)
lab.
(pg/lab.)
tube
(m mol/cm)
lab.
(m mol/lab.)
Tube
(m mol/cm)
lab.
(m mol/lab.)
tube
(m mol/cm)
lab.
(m mol/lab.)
New0.020.20.040.010.10.3bd bd bd bd àMethane0.030.40.249.800.1 1.80.03bd0.510.3tMethane0.130.7 2.0022.00.77.50.15 2.10 3.132.2 S Al Fe Si
tube
(m mol/cm)lab.
(m mol/lab.)
tube
(m mol/cm)
lab.
(m mol/lab.)
tube
(m mol/cm)
lab.
(m mol/lab.)
tube
(m mol/cm)
lab.
(m mol/lab.)
New0.2 2.8bd0.10.030.30bd bd àMethane0.2 2.00.47.10.20 5.90bd 1.1tMethane0.7 2.8 2.324.10.949.40 2.752.0 Concentrations are expressed per cm tube or per‘labyrinth-inner-disc’.lab.:labyrinth-inner-disc;bd:below detection limit.80
C. de Kreij et al. / Agricultural Water Management 60 (2003) 73–85
Mean TOC concentrations in series 1and 2in tube emitters were 0.05(?0.03;n ?8)and 0.12(?0.06;n ?8)mg/cm tube for ‘àmethane ’and ‘tmethane ’treatments,respectively.Mean TOC concentrations in labyrinths emitters were 1.1(?0.5;n ?8)and
2.1(?1.1;n ?8)mg per ‘labyrinth-inner-disc ’for ‘àmethane ’and ‘tmethane ’,respectively.
In the tube emitter with ‘tmethane ’treatment,higher mean Ca,Mg,P and Al contents were found than in the ‘àmethane ’emitter.The difference between ‘àmethane ’and ‘tmethane ’for S,Mn and Fe were variable.The same applied to the labyrinth emitters (data not shown).The TOC,ATP and element concentrations of the emitters at the end of series 2are given in Table 3.In the ‘àmethane ’treatment all concentrations were lower than in the ‘tmethane ’.
3.3.Effect of acids and commercial products on Trichoderma
The effect of the acids is given in Fig.3.The ef ?cacy is negative which means that the acids promote the growth of Trichoderma relative to the control (no organic acids).The effects of the commercial products are given in Fig.4.In demineralised water,the products are effective.However,in drain water,most products are not effective even at the highest concentration.Product E promotes the growth of Trichoderma in drain water.There is no consistent difference between T.atroviride and T.virens .
4.Discussion
4.1.Ground water,reverse osmosis and volatilisation
Very high concentrations of methane (up to 69mg/l)were found in the ground water of growers with severe emitter clogging compared to ground water from drinking water wells (3–20mg/l).Methane is very volatile which can be seen from the signi ?cant difference between the concentration in the ground water and the fertiliser-mixing tank.This high volatilisation could also cause problems with sampling,which needs to be very accurate.During transport of samples it was found that methane in the sampling bottles had been ‘consumed ’.Addition of copper sulphate (CuSO 4á5H 2O at 3mg/l)and chilling
was
Fig.3.Efficacy (mortality),relative to control of T.atroviride (closed symbol)and T.virens (open symbol)affected by acetic acid and formic acid.
C.de Kreij et al./Agricultural Water Management 60(2003)73–8581
adequate to keep the concentration constant during transport to the laboratory (data not shown).Chilling had been carried out in all samples but not the addition of copper.So,on a few occasions there was some doubt about the correct concentration of methane;in these cases,the real methane concentration is higher than the reported one.Methane concentra-tions of ground water and the same water processed by reverse osmosis were equal.Reverse osmosis proved not capable removing methane.
The three growers who installed extra volatilisation lowered the methane concentration in the fertiliser-mixing tank (MT);however,methane was still detected in the mixing tank.To exclude methane,continuous spraying of the water should be practised,which is now recommended to growers with methane in ground water (van der Burg,1998a,b ).
4.2.Effect of methane on discharge rate and variation of emitters
Mean methane concentrations in the recirculation tank of 0.11mg/l and in the discharged solution from the emitters of 0.08mg/l caused severe clogging of the tube emitters.The discharge diminished and the coef ?cient of variation increased.Methane concentration in fertiliser-mixing tanks should be lower than 0.11mg/l and in the discharged solution lower than 0.08mg/l.
Labyrinth emitters have lower sensitivity to clogging than tube emitters due to turbulent ?ow in the labyrinth in comparison to the laminar ?ow in the tube emitter.However,
in
Fig.4.Efficacy (mortality),relative to control of T.atroviride and T.virens in demineralised water and drain water,affected by commercial products (A –E).Arrow denotes recommended concentration in practical conditions.
82 C.de Kreij et al./Agricultural Water Management 60(2003)73–85
C.de Kreij et al./Agricultural Water Management60(2003)73–8583 series1,the coef?cient of variation of the labyrinth emitters increased to about20%,which is considered bad(Decroix,1990)and the rate also diminished in series2.Visual examination(naked eye and microscopic)showed tiny rockwool?bres in the labyrinths but not in the tubes.This combination of?bres and methane was the cause of the clogging of the labyrinth emitters.
The ATP concentrations in the tanks(means of40and163ng/l for‘àmethane’and‘tmethane’treatments,respectively)were higher than those found in non-treated ground water or surface water,being<1to23ng/l(Van der Kooij,1992).This is logical since the tanks contained fertiliser which promoted bacterial and/or fungal growth.
In the slime of the‘tmethane’emitters,higher TOC content and higher levels of Ca, Mg,P,S,Al,Fe and Si were found than in the‘àmethane’treatment.This showed that the slime is a combination of organic and inorganic deposits.It is possible that slime formation increased the deposits of salts due to a higher pH and/or physical aspects in the slime.The pH of the tanks was maintained at5.8.It is possible that higher pH occurred in the emitter slime than in the tanks and the recirculating solution.This could result in the insolubility of Ca,Mg,Fe,P,S,Al and Si.Adin and Sacks(1991)have mentioned the extra clogging by particles in bacterial slime and the effect of methane on the deposition of salts(scaling) should also be considered.
4.3.Effect of organic acids and commercial products on Trichoderma
Acetic acid and formic acids increased the growth of Trichoderma.These acids,and probably all organic acids,should not be used as preventive chemicals.The use of organic acids is discouraged based on the presented research(Disco,2000).The organic acids serve as substrate for the growth of https://www.wendangku.net/doc/d43673201.html,mercial products were only effective in demineralised water and,since drain water is recycled,it is more important to know the effect on drain water,which was mostly disappointing.Some concentrations of commercial product E containing formic acid and low hydrogen peroxide,gave an increase of Trichoderma, which coincides with the?nding of formic acid alone.After2years,L?schenkohl(1994) found Trichoderma as the predominant fungus in a closed solution ebb and?ow system for pot plants with the addition of a product containing13%hydrogen peroxide and4.5% peracetic acid.Boman and Ontermaa(1994)mentioned synthetic polymers as anti-scalants but the carbon of the polymers could act as a substrate for micro-organisms and thereby promote biofouling.This has already been found in processing drinking water,where some organo-phosphonates and polyacrylic acids,used as anti-scalants,caused biofouling(Vrou-wenvelder et al.,2000).It is likely that during long exposure certain bacteria and fungi favour the extra food supplied by the organic acids(Profaizer et al.,1997)and as emitters in greenhouses never dry,passing oxygen-containing,fertilised solution at optimal tempera-tures,the bacteria and fungi have the perfect environment for growth.
5.Conclusions
Growers with severe emitter clogging had high methane concentrations in the ground water.Methane concentrations of0.11mg/l in the fertiliser-mixing tank clogged the tube
84 C.de Kreij et al./Agricultural Water Management60(2003)73–85
emitter and in the long term also the labyrinth emitters.Formic and acetic acid promoted the growth of Trichoderma,a fungus often isolated from emitter https://www.wendangku.net/doc/d43673201.html,mercial anti-clogging agents(containing organic acids)were not capable of killing Trichoderma added to drain water.In clogged emitters in the‘tmethane’treatment,organic deposits (biofouling)promoted salts deposition(scaling).
Acknowledgements
This study has been?nanced by the Ministry of Agriculture,Nature and Fisheries,the Product Board of Horticulture and the Commissie Schikkingsgelden Rijnproces. References
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joinin剑桥小学英语
Join In剑桥小学英语(改编版)入门阶段Unit 1Hello,hello第1单元嗨,嗨 and mime. 1 听,模仿 Stand up Say 'hello' Slap hands Sit down 站起来说"嗨" 拍手坐下来 Good. Let's do up Say 'hello' Slap hands Sit down 好. 我们来再做一遍.站起来说"嗨"拍手坐下来 the pictures. 2 再听一遍给图画编号. up "hello" hands down 1 站起来 2 说"嗨" 3 拍手 4 坐下来说 3. A ,what's yourname 3 一首歌嗨,你叫什么名字 Hello. , what's yourname Hello. Hello. 嗨. 嗨. 嗨, 你叫什么名字嗨,嗨. Hello, what's yourname I'm Toby. I'm Toby. Hello,hello,hello.嗨, 你叫什么名字我叫托比. 我叫托比 . 嗨,嗨,嗨. I'm Toby. I'm Toby. Hello,hello, let's go! 我是托比. 我是托比. 嗨,嗨, 我们一起! Hello. , what's yourname I'm 'm Toby. 嗨.嗨.嗨, 你叫什么名字我叫托比.我叫托比. Hello,hello,hello. I'm 'm Toby. Hello,hello,let's go! 嗨,嗨,嗨.我是托比. 我是托比. 嗨,嗨,我们一起! 4 Listen and stick 4 听和指 What's your name I'm Bob. 你叫什么名字我叫鲍勃. What's your name I'm Rita. What's your name I'm Nick. 你叫什么名字我叫丽塔. 你叫什么名字我叫尼克. What's your name I'm Lisa. 你叫什么名字我叫利萨. 5. A story-Pit'sskateboard. 5 一个故事-彼德的滑板. Pa:Hello,Pit. Pa:好,彼德. Pi:Hello,:What's this Pi:嗨,帕特.Pa:这是什么 Pi:My new :Look!Pi:Goodbye,Pat! Pi:这是我的新滑板.Pi:看!Pi:再见,帕特! Pa:Bye-bye,Pit!Pi:Help!Help!pi:Bye-bye,skateboard! Pa:再见,彼德!Pi:救命!救命!Pi:再见,滑板! Unit 16. Let's learnand act 第1单元6 我们来边学边表演.
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Join In剑桥小学英语.doc
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处理医嘱流程
处理医嘱流程 本科室病人多，年轻护士多，主班工作相对繁琐，我将就处理医嘱的流程和我在主班工作中的一些心得和大家一起分享。希望我的分享能够对大家有所帮助。 1. 主班收新病人流程：安排床位，通知护工铺床，通知A组和医生，电脑入区，填写腕带、一览表卡、床头卡，处理医嘱（转抄医嘱、打印治疗单并传递给A班护士、长期医嘱绑费、临时医嘱收费、打印条码）。 2. 办理病人出院流程：审核并执行出院病人临时医嘱，停止一切治疗单，在一览表卡背面注明床号、转归、住院天数，查收氧气本上的费用，退费（血氧饱和度、血糖），电脑出区，整理出院病历，病人结账资料交护工送收费室，出院带药处方交A班，通知A班打印病历。（温馨提示：出院病人如需拿药退药，应待药房确认后方能办理电脑出区） 3. 处理转科医嘱：审核执行转科临时医嘱，停止一切治疗单，在一览表卡背面注明床号、转往何科，查收氧气本上的费用，退
费（血氧饱和度、血糖），通知A组打印病历，电脑转区，整理转科病历，病人病历交护工送对方科室,由转入科室接病人入区。转往ICU的病人则由本科护士护送。接收转区病人则由主班接到转科病历后，安排床位，再由护工接病人入区。 （温馨提示：待病历打印后办理电脑转区；转科病人如需拿药退药，应待药房确认后方能办理电脑转区；转区前医生停止长期医嘱。） 4. 处理转床医嘱：电脑上转床，更改床位费，转各种治疗单，转病历夹，通知A班转病人，治疗班更改长期摆药的床号。 5. 停止长期医嘱的处理：（1）停止药品的医嘱：审核，停止治疗单，退费。（温馨提示：当天长期药品已执行的要退药，注意退药和退费的频次，通知治疗班提出药品。退费项目中有输液的，需在未停止药品组中重新绑定输液。）（2）停止其他治疗的医嘱：转抄医嘱在临时治疗单，退费，须立即执行的及时通知A班。 6. 临时医嘱的处理：(1)口服药：审核执行，
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附表2 董事、监事、经理信息 姓名职务身份证件类型身份证件号码_______________ （身份证件复印件粘贴处） 姓名职务身份证件类型身份证件号码_______________ （身份证件复印件粘贴处） 姓名职务身份证件类型身份证件号码_______________ （身份证件复印件粘贴处）
医嘱书写要求及格式
医嘱书写要求及格式 医嘱是指医师在医疗活动中下达的医学指令。医嘱单分为长期医嘱单和临时医嘱单。 一、医嘱书写的基本要求 1.取得医疗机构处方权的医师有权在本医疗机构开具医嘱。试用期人员书写的医嘱，应当经所在医疗机构有处方权的执业医师审核并签名。进修医师由接收进修的医疗机构对其胜任本专业工作的实际情况进行认定后授予相应的医嘱权利。 麻醉药品和第一类精神药品的开具按相关规定执行。 2.医嘱内容及起始、停止时间应当由医师书写。医嘱由医师直接书写在医嘱单上或输入微机，护士不得转抄转录。 3. 医嘱内容应当准确、清楚，每项医嘱应当只包含一个内容，并注明下达时间，应当具体到分钟。 4.医嘱不得涂改。需要取消时，应当使用红色墨水标注“取消”字样并签名。 5.药品名称、剂量、单位等书写要求详见本章第一节。 6.一般情况下，医师不得下达口头医嘱。因抢救急危患者需要下达口头医嘱时，护士应当复诵一遍。抢救结束后，医师应当即刻据实补记医嘱。 二、长期医嘱及长期医嘱单 （一）概念 长期医嘱指自医师开写医嘱时起，可继续遵循至医嘱停止的医学指令。长期医嘱书写在长期医嘱单上。长期医嘱单包括患者姓名、科别、住院病历号(或病案号)、页码、起始日期和时间、长期医嘱内容、停止日期和时间、医师签名、执行时间、执行护士签名。 （二）长期医嘱书写注意事项 1.长期医嘱的内容包括：护理常规类别、护理级别、病危与否、饮食、体位、药物(名称、剂量、给药途径及用法)、各种治疗操作等。 2.同一日期、同一时间开写的多项医嘱，仅在第一项医嘱的日期和时间栏内写清具体日期和时间，在其他各项医嘱的日期和时间栏内可用“〃”代替。 3.开写医嘱时在医嘱栏内顶格书写，如一行写不完应在第二行的行首空一字格书写，如第二行仍未写完，第三行第一个字应与第二行第一个字对齐书写，
医嘱查对制度与执行流程图
医嘱查对制度与执行流程 一、医嘱查对制度 （1）处理长期医嘱或临时医嘱时要记录处理时间，执行者签全名，若有疑问必须问清楚后方可执行。各班医嘱均由当班护士两名进行查对。 （2）主管护士和夜班护士对当日医嘱要进行查对，每周定期大核对两次，并根据需要进行重整。整理医嘱后需经另一人查对，方可执行。 （3）对有疑问的医嘱必须问清楚后，方可执行。 （4）抢救病员时，医师下达口头医嘱，执行者须复诵一遍，经双方核实无误后，方可执行。用过的空安瓿，须经2人核对后再弃去。抢救结束后６小时内据实补齐医嘱并签字。 （5）整理医嘱、治疗卡、服药卡后，须经2人查对。 （6）护士长每周总查对医嘱2次。 二、医嘱执行流程： （1）医嘱处理护士接医生下达的医嘱后，认真阅读及查对。 （2）查对医嘱无质疑后确认医嘱。 （3）医嘱处理护士按医嘱执行要求的缓急分配给护士执行。 （4）医嘱执行护士接医嘱执行单后，认真查对，严格按照医嘱的内容、时间等要求准确执行，不得擅自更改。 （5）医嘱执行后，应认真观察疗效与不良反应，必要时进行记录并及时与医生反馈。 紧急情况下口头医嘱制度与执行流程 1、在非抢救情况下，护士不执行抢救医嘱及电话通知的医嘱，口头医嘱只有在抢救或手术中可以执行。 2、危重抢救过程中，医生下达口头医嘱后，护士需复诵一遍，得到医生确认后方可执行。 3、在执行口头医嘱给药时，需请下达医嘱者再次核对药物名称，剂量及给药途径，以确保用药安全。 4、抢救结束医生应及时补记所下达的口头医嘱，保留用过的空安瓶，须经两人核对记录后方可弃去。
5、在接获电话医嘱或重要检验结果时，接听护士需对医嘱内容或检验结果进行复述，确认无误后方能记录和执行。 6、对擅自执行口头医嘱行为视为违规，一经发现将给予处理 一、口头医嘱制度 1、一般情况下不执行口头医嘱，口头医嘱仅限于紧急抢救、手术时执行。 2、紧急情况下医生可下达口头医嘱，护士执行时必须复诵一遍，确认无误后执行。 3、给药时，须与医生再次核对药物的名称、计量、用法，确保用药安全。 4、保留用过的空安瓿，以备查对。 5、将口头医嘱内容及时登记在抢救用药记录本上。 6、抢救结束后6小时内，医生根据抢救用药记录补开医嘱。 7、护士在医嘱单上签名。 8、对违反以上规定者，给予处理。 二、口头医嘱执行流程 （1）医生下达口头遗嘱 （2）护士复诵一遍 （3）与医生共同核对药物 （4）实施治疗护理 （5）保留空安瓿 （6）记录口头医嘱内容 （7）医生补开医嘱 （8）护士签名
剑桥小学英语Join_In
《剑桥小学英语Join In ——Book 3 下学期》教材教法分析2012-03-12 18:50:43| 分类：JOIN IN 教案| 标签：|字号大中小订阅. 一、学情分析： 作为毕业班的学生，六年级的孩子在英语学习上具有非常显著的特点： 1、因为教材的编排体系和课时不足，某些知识学生已遗忘，知识回生的现象很突出。 2、有的学生因受学习习惯及学习能力的制约，有些知识掌握较差，学生学习个体的差异性，学习情况参差不齐、两级分化的情况明显，对英语感兴趣的孩子很喜欢英语，不喜欢英语的孩子很难学进去了。 3、六年级的孩子已经进入青春前期，他们跟三、四、五年级的孩子相比已经有了很大的不同。他们自尊心强，好胜心强，集体荣誉感也强，有自己的评判标准和思想，对知识的学习趋于理性化，更有自主学习的欲望和探索的要求。 六年级学生在英语学习上的两极分化已经给教师的教学带来很大的挑战，在教学中教师要注意引导学生调整学习方式： 1、注重培养学生自主学习的态度 如何抓住学习课堂上的学习注意力，吸引他们的视线，保持他们高涨的学习激情，注重过程的趣味化和学习内容的简易化。 2、给予学生独立思考的空间。 3、鼓励学生坚持课前预习、课后复习的好习惯。 六年级教材中的单词、句子量比较多，难点也比较多，学生课前回家预习，不懂的地方查英汉词典或者其它资料，上课可以达到事半功倍的效果，课后复习也可以很好的消化课堂上的内容。 4、注意培养学生合作学习的习惯。 5、重在培养学生探究的能力：学习内容以问题的方式呈现、留给学生更多的发展空间。 二、教材分析： （一）.教材特点： 1．以学生为主体，全面提高学生的素质。
有限合伙企业登记注册操作指南
有限合伙企业登记注册操作指南 风险控制部 20xx年x月xx日
目录 一、合伙企业的概念 (4) 二、有限合伙企业应具备的条件 (4) 三、有限合伙企业设立具备的条件 (4) 四、注册有限合伙企业程序 (5) 五、申请合伙企业登记注册应提交文件、证件 (6) （一）合伙企业设立登记应提交的文件、证件： (6) （二）合伙企业变更登记应提交的文件、证件： (7) （三）合伙企业注销登记应提交的文件、证件： (8) （四）合伙企业申请备案应提交的文件、证件： (9) （五）其他登记应提交的文件、证件： (9) 六、申请合伙企业分支机构登记注册应提交的文件、证件 (9) （一）合伙企业分支机构设立登记应提交的文件、证件 (10) （二）合伙企业分支机构变更登记应提交的文件、证件： (10) （三）合伙企业分支机构注销登记应提交的文件、证件： (11) （四）其他登记应提交的文件、证件： (12) 七、收费标准 (12) 八、办事流程图 (12) （一）有限合伙企业创办总体流程图（不含专业性前置审批） (12) （二）、工商局注册程序 (15)
（三）、工商局具体办理程序（引入网上预审核、电话预约方式） (16) 九、有限合伙企业与有限责任公司的区别 (16) （一）、设立依据 (16) （二）、出资人数 (16) （三）、出资方式 (17) （四）、注册资本 (17) （五）、组织机构 (18) （六）、出资流转 (18) （七）、对外投资 (19) （八）、税收缴纳 (20) （九）、利润分配 (20) （十）、债务承担 (21) 十、常见问题解答与指导 (21)
医嘱管理制度流程
医嘱管理制度 一、政策 由临床医生为病人下达医嘱，必须遵循的制度。 二、目的 对临床医务人员在医嘱下达和执行过程中的行为进行规范，以确保医疗质量和医疗安全。 三、标准 1、医嘱必须由获得本院处方权的职业医生在其范围内下达，只有经医务部核准，有处方权资格的医生才可以下达电子医嘱或手写（必要时）医嘱。没有处方权的医生只能在带教医生指导下开医嘱，并由带教医生审核签名后方可发送，医嘱所产生的法律责任由带教医生承担。医院不允许无处方权的医生在没有带教医生的指导下开出医嘱。 2、医嘱分为长期医嘱、临时医嘱（24小时以内的医嘱，或者只执行一次，但持续时间超过24小时的医嘱，化疗泵给药）、口头医嘱。住院病人的所有医嘱都要记录在病历中固定的记录单，如医嘱单、麻醉记录单。医嘱单包括长期医嘱单、临时医嘱单和口头医嘱单。药学人员、护理人员执行电子医嘱，特殊情况下执行口头医嘱或手写医嘱。在病区抢救时或手术中所用的口头医嘱应在抢救结束后6小时内或手术结束时补录医嘱。门诊病人的所有医嘱要记录在门诊病历中。获得病人医嘱的方式有两种：电子医嘱在HIS系统中可查询；纸质医嘱在病历中可获得。住院病人医嘱由医生下达，药物治疗医嘱由药学人员核对、其他医嘱由护士双人核对后执行。 3、新入院病人、转科、手术后病人的医嘱应在病人达到病房后2小时内开出，急诊病人、危重病人一般要求在半小时
内开出。每天例行查房的医嘱要求在上午11时以前开出，但病情变化可以随时开出医嘱。 4、医嘱原则上要求层次分明，入院病人的长期医嘱先后顺序要符合医院要求。下达医嘱的时间要精确到分。 5、药物医嘱需写明药物的通用名称、用量、用法、数量。静脉输液超过一组应分组列出配方及使用顺序。静脉滴注药物的一般输液速度按标准医嘱执行：为20～40滴/分钟，需要超过此范围时医生要注明每分钟的滴速或毫升数。用药途径（如：口服）、药物单位（如：克）等内容都不可以省略。 ⑴特殊药物的使用要求：抗生素、抗凝药、止血药、抗心律失常药、环孢霉素A等药物必须按Q×h给药，如Q6h、Q8h、Q12h。 ⑵对高危药品，如麻醉药、麻醉辅助药、化疗药、电解质、高级别抗生素的使用要按照医院的相关规定执行，药剂科要进行监督，如有违反规定适时向临床医生发出书面通知，建议临床医生及时停药。临床医生在收到通知时要及时报告上级医师，考虑停药或者向药剂科说明理由。没有停药又没有合理说明者应由药剂科及时报告医务部和质控办。 ⑶“自理”品管理规定：由病人或病人家属在医院内自己使用的药品称自理药品。目前仅限于使用外用药、漱口液。首先医生评估确定病人可安全自用外用药，然后在临时医嘱栏开出外用药物医嘱并应详细写明药物的用法、用量、频次、使用天数等内容。护士发药时向病人/家属详细讲解药物使用方法及注意事项，并教育病人/家属在用药前后洗手，以确保病人正确、安全的使用自理药物。同时临床医生及护士要观察药物使用情况、疗效及副作用。当医生评估不能确保病人自理药的安全时，由医生开出长期医嘱，护士根据医嘱执行。 ⑷“自备”药品医嘱：如果药品是“自备”的，按自备药品管理制度执行。
剑桥小学英语join in五年级测试卷
五 年 级 英 语 测 试 卷 学校 班级 姓名 听力部分（共20分） 一、Listen and colour . 听数字，涂颜色。（5分） 二、 Listen and tick . 听录音，在相应的格子里打“√”。 （6分） 三、Listen and number.听录音，标序号。（9分） pig fox lion cow snake duck
sheep 笔试部分（共80分） 一、Write the questions.将完整的句子写在下面的横线上。(10分) got it Has eyes on a farm it live sheep a it other animals eat it it Is 二、Look and choose.看看它们是谁，将字母填入括号内。(8分) A. B. C. D.
E. F. G. H. ( ) pig ( ) fox ( ) sheep ( ) cat ( ) snake ( ) lion ( ) mouse ( ) elephant 三、Look at the pictures and write the questions.看图片，根据答语写出相应的问题。(10分) No,it doesn’t. Yes,it is.
Yes,it does. Yes,it has. Yes,it does. 四、Choose the right answer.选择正确的答案。(18分) 1、it live on a farm？ 2. it fly？
3. it a cow？ 4. it eat chicken？ 5. you swim？ 6. you all right？ 五、Fill in the numbers.对话排序。(6分) Goodbye. Two apples , please. 45P , please. Thank you.
公司注册登记流程(四证)
→客户提供：场所证明租赁协议身份证委托书三张一寸相片 →需准备材料：办理税务登记证时需要会计师资格证与财务人员劳动合同 →提交名称预审通知书→公司法定代表人签署的《公司设立登记申请书》→全体股东签署的《指定代表或者公共委托代理人的证明》（申请人填写股东姓名）→全体股东签署的公司章程（需得到工商局办事人员的认可）→股东身份证复印件→验资报告（需到计师事务所办理：需要材料有名称预审通知书复印件公司章程股东身份证复印件银行开具验资账户进账单原件银行开具询证函租赁合同及场所证明法人身份证原件公司开设临时存款账户的复印件）→任职文件（法人任职文件及股东董事会决议）→住所证明（房屋租赁合同）→工商局（办证大厅）提交所有材料→公司营业执照办理结束 →需带材料→公司营业执照正副本原件及复印件→法人身份证原件→代理人身份证→公章→办理人开具银行收据交款元工本费→填写申请书→组织机构代码证办
理结束 →需带材料→工商营业执照正副本复印件原件→组织机构正副本原件及复印件→公章→公司法定代表人签署的《公司设立登记申请书》→公司章程→股东注册资金情况表→验资报告书复印件→场所证明（租赁合同）→法人身份证复印件原件→会计师资格证（劳动合同）→税务登记证办理结束 →需带材料→工商营业执照正副本复印件原件→组织机构正副本原件及复印件→税务登记证原件及复印件→公章→法人身份证原件及复印件→代理人身份证原件及复印件→法人私章→公司验资账户→注以上复印件需四份→办理时间个工作日→办理结束 →需带材料→工商营业执照正副本复印件原件→组织机构正副本原件及复印件→公章→公司法定代表人签署的《公司设立登记申请书》→公司章程→股东注册资金情况表→验资报告书复印件→场所证明（租赁合同）→法人身份证复印件原件→会计师资格证（劳动合同）→会计制度→银行办理的开户许可证复印件→税务登记证备案办理结束
(完整版)剑桥小学英语Joinin六年级复习题(二)2-3单元.doc
2011-2012 学年度上学期六年级复习题（Unit2-Unit3 ） 一、听力部分 1、听录音排序 ( ) () ()() () 2、听录音，找出与你所听到的单词属同一类的单词 （） 1. A. spaceman B. pond C . tiger （） 2. A.mascots B. potato C . jeans （） 3. A. door B. behind C . golden （） 4. A. sometimes B. shop C . prince （） 5. A. chair B. who C . sell 3、听录音，将下面人物与他的梦连线 Sarah Tim Juliet Jenny Peter 4、听短文，请在属于Mr. Brown的物品下面打√ ( ) ( ) ( ) ( ) ( ) ( ) ( ) 5、听问句选答句 （） 1. A. Yes, I am B. Yes, I have C . Yes, you do （） 2. A.Pink B. A friendship band C . Yes. （） 3. A. OK B. Bye-bye. C . Thanks, too. （） 4. A. Monday. B. Some juice. C . Kitty. （） 5. A. I ’ve got a shookbag. B. I ’m a student. C . It has got a round face. 6、听短文，选择正确答案 （） 1. Where is Xiaoqing from? She is from . A.Hebei B. Hubei C . Hunan （） 2. She goes to school at . A.7:00 B.7:30 C . 7:15 （） 3. How many classes in the afternoon? classes. A. four B. three C . two （） 4. Where is Xiaoqing at twelve o ’clock? She is . A. at home B. at school C .in the park （） 5. What does she do from seven to half past eight? She . A.watches TV B. reads the book C. does homework
医嘱分类及规范
根据医嘱的时效性和内容，分别对不同医嘱的书写规范描述如下： 2.1. 长期医嘱 长期医嘱包括患者姓名、科室、病区、床号、住院号、起始时间、医嘱内容、医师签名、停止时间、停止医师签名、执行时间（首次执行）、执行人签名。 医嘱内容的要求详见后。 2.2. 临时医嘱 临时医嘱包括患者姓名、科室、病区、床号、住院号、医嘱下达时间、医嘱内容、医师签名、执行时间、执行人签名。 医嘱内容同长期医嘱。 医师在书写医嘱时，需要区分长期医嘱和临时医嘱，但不会刻意区分医嘱内容是哪种内容，而是连续书写下来。所以在录入医嘱时应区分长期医嘱和临时医嘱，而不要强制区分药物医嘱或诊疗医嘱等。 2.3. 医嘱内容 2.3.1. 护理医嘱 护理医嘱内容一般包括：护理常规、护理等级、病重或病危（如果不是可以写）、隔离种类（如无特殊可以不写）、饮食、体位（如无特殊可以不写）、陪客（可以不写）。大部分护理医嘱与费用无关，处理类似于嘱托医嘱，有些护理医嘱与费用相关，如护理等级，处理类似于诊疗医嘱。 2.3.2. 嘱托医嘱 嘱托医嘱是指医师在医疗过程中对患者或诊治过程的嘱咐，一般情况下嘱托医嘱是一种自由文字，不涉及费用收取。如“饭后少量活动”、“严禁饮酒”等。2.3.3. 西药及中成药医嘱 西药和中成药医嘱是用药医嘱的一种，也是医嘱中最常见的内容，包括：药物名称、单次剂量、每日用次、给药途径、是否皮试、注意事项等。 西药及中成药医嘱中应使用药物（或药品）的通用名，不允许使用商品名，在一般情况下，医师下达的医嘱是药物，再由药房药剂师调剂，决定具体使用哪种药品（药物与药品关系见后续章节），在个别情况下也可以由医生指定使用的药品。所以在录入用药医嘱时，应当由医生按照药物进行录入，由系统根据药房缺省指定的药品进行处理，同时允许医生变更药物对应的药品，系统自动根据药品的规格，按照医嘱中单次剂量和每日用次，结合药品的药房包装，计算出实际药品在药房包装下的用量，再结合药品单价计算费用。无论是药物还是药品，医师下医嘱时都不关心药品的批次。 2.3.4. 中草药医嘱 中草药医嘱涉及到中草药处方，将其视作为一条西药医嘱，在医嘱中一般用“X XX草药汤剂”来替代，在医嘱不书写草药的明细内容，而是对应一张草药处方。中草药医嘱可以下在长期医嘱中，也可以下在临时医嘱中。 中草药处方按照“付”计算，在生成取药单时，不能将所有组成草药合计计算，应先按处方计算，然后乘以“付”数。
外研社剑桥小学英语Join_in四年级上册整体课时教案
外研社剑桥小学英语Join_in四年级上册整体课时教案Starter Unit Let's begin 第一学时: The pupils learn to understand: How are you today? I’m fine/OK. Goodbye. The pupils learn to use: What’s your name? I’m (Alice). How are you? I’m fine. I’m OK. Activities and skills: Decoding meaning from teacher input. Using phrases for interaction in class. Greeting each other. I Introduce oneself. Asking someone’s mane. Teaching process: Step 1: Warm—up. Sing a song. Hello, what’s your name? Step 2: Presentation. 1. What’s your name? I’m…. (1) The teacher introduces herself, saying: Hello, /Good morning, I’m Miss Sun. (2) Asks a volunteer’s name:
What’s your name? The teacher prompt the pupil by whispering, I’m (Alice). (3) Asks all the pupils the same question and help those who need it by whispering I’m…. 2. How are you today? I’m fine. I’m OK. (1) The teacher explains the meaning of How are you today? (2) Tell the class to ask the question all together and introduce two answers, I’m (not very) fine/I’m Ok. (3) Asks all the pupils the same question and make sure that all the students can reply. Step3: Speak English in class. 1. Tells the pupils to open their books at page3, look at the four photographs, and listen to the tape. 2. Asks the pupils to dramatise the situations depicted in the four photographs. A volunteer will play the part of the parts of the other pupils, answering as a group. 第二学时: The pupils learn to use these new words: Sandwich, hamburger, hot dog, puller, cowboy, jeans, cinema, walkman, snack bar, Taxi, clown, superstar.
代理公司注册登记协议书简易版
It Is Necessary To Clarify The Rights And Obligations Of The Parties, To Restrict Parties, And To Supervise Both Parties To Keep Their Promises And To Restrain The Act Of Reckless Repentance. 编订：XXXXXXXX 20XX年XX月XX日 代理公司注册登记协议书 简易版
代理公司注册登记协议书简易版 温馨提示：本协议文件应用在明确协议各方的权利与义务、并具有约束力和可作为凭证，且对当事人双方或者多方都有约制性，能实现监督双方信守诺言、约束轻率反悔的行为。文档下载完成后可以直接编辑，请根据自己的需求进行套用。 代理公司注册登记协议书 甲方：_________ 地址：_________ 电话：_________ 联系人：_________ 乙方：_________ 地址：_________ 电话：_________ 联系人：_________ 为了充分发挥_________的资源和信息服务优势，甲、乙双方经过友好协商，本着平等互利、友好合作的意愿达成本协议书，并郑重声
明共同遵守： 一、甲方同意按照本协议的规定，授权乙方为其代办公司注册手续。 二、乙方提供的代办咨询服务范围仅限如下： 1.为甲方代办工商营业执照、组织机构代码证、税务证、三章(法人章、公章、财务章); 2.约定的其他服务： _________。 三、甲方的责任： 1.甲方应指定专人配合乙方完成新企业工商登记注册等事务，并提供齐全的证件和规范的法律文件资料。 2.甲方对提供的证件和法律文件资料的真实性、正确性、合法性承担全部责任。
医嘱执行制度及流程
医嘱执行制度及流程 一、医嘱执行制度： 1.医嘱必须由在本院拥有两证（医师资格证和执业证）和处方权的医师开具方可执行，医生将医嘱直接写在医嘱本上或电脑上，为避免错误，护士不行代录医嘱。 2.执行医嘱的人员，必须是本院具备注册护士资格的人员，其它人员不得执行医嘱。 3.医生在计算机上下达医嘱后，护士应查对医嘱内容的正确性及开始的执行时间，严格执行医嘱，不得擅自更改。对临时医嘱必须在规定的时间15分钟内执行。如发现医嘱中有疑问或不明确之处，应及时向医师提出，明确后方可执行。必要时护士有权向上级医师及护士长报告,不得盲目执行。因故不能执行医嘱时，应当及时报告医师并处理。 3.病区护士站的文员负责打印医嘱执行单，并交由管床的责任护士核对执行，责任护士执行医嘱后，在医嘱执行单上签署执行时间和姓名。 4.在执行医嘱的过程中，必须严格遵守查对制度，以防差错和事故的发生。执行医嘱时须严格执行床边双人查对制度。 5.一般情况下，护士不行执行医师的口头医嘱。因抢救急危患者需要执行口头医嘱时，护士应当复诵一遍无误后方可执行。抢救结束后，护士应及时在医师补录的医嘱后签上执行时间和执行人姓名。 6.凡需下一班执行的临时医嘱，应向有关人员交待清楚，做好标本容器、特殊检查要求（如禁食、术前用药等）各项准备，并在交班报告中详细交班。
7.病人手术、转科、出院或死亡后，应及时停止以前医嘱，重新执行术后或转科后医嘱。 8.护士每班应查对医嘱，接班后应检查上一班医嘱是否处理完善，值班期间应随时进入工作站查看有无新开医嘱。护士长对所有的医嘱每周总核对一次。并在《医嘱核对登记本》上签名，发现错误应立即更正。护理部应定期抽查各科室医嘱核对情况。 9.无医师医嘱时，护士一般不得给患者进行对症处理。但遇抢救危重患者的紧急情况下，医师不在现场，护士可以针对病情临时给予必要处理，但应当做好记录并及时向经治医师报告。 10.根据医嘱和各项处置内容的收费标准进行累计收费。随时核对住院病人医疗费用，及时进行补充收费。 附：医嘱种类 （一）长期医嘱：有效时间在24小时以上，医师注明停止时间后即失效。 （二）临时医嘱：有效时间在24小时以内，应在短时间内执行，需要时立即执行。 （三）备用医嘱：根据病情需要分为长期备用医嘱（PRN）和临时备用医嘱（SOS）二种。 二、执行医嘱流程： 1.医嘱处理护士接医生下达的医嘱后，认真阅读及查对。 2.查对医嘱无质疑后确认医嘱。 3.医嘱处理护士按医嘱执行要求的缓急分配给护士执行。 4.医嘱执行护士接医嘱执行单后，认真查对，严格按照医嘱的内容、时间等要求准确执行，不得擅自更改。 5.医嘱执行后，应认真观察疗效与不良反应，必要时进行记录并及时与医生反馈。
医嘱制度与执行流程
奇台县人民医院医嘱制度与执行流程（修订） 一、医嘱制度 １．医嘱一般在上班后二小时内开出，要求层次分明，内容清楚。转抄和整理必须准确，一般不得涂改。如须更改或撤销时，应用红笔填“取消”字样并签名。临时医嘱应向护士交代清楚。医嘱要按时执行。开写、执行和取消医嘱必须签名并注明时间。 ２．医师写出医嘱后，要复查一遍。护士对可疑医嘱，必须查清后方可执行。除抢救或手术中不得下达口头医嘱，下达口头医嘱，护士需复诵一遍，经医师查对药物后执行，医师要及时补记医嘱。每项医嘱一般只能包含一个内容。严禁不看病人就开医嘱的草率作风。 ３．护士每班要查对医嘱，夜班查对当日医嘱，每周由护士长组织总查对一次。转抄、整理医嘱后，需经另一人查对，方可执行。 ４．手术后和分娩后要停止术前和产前医嘱，重开医嘱，并分别转抄于医嘱记录单和各项执行单上。 ５．凡需下一班执行的临时医嘱，要交代清楚，并在护士值班记录上注明。 ６．医师无医嘱时，护士一般不得给病员做对症处理。但遇抢救危重病人的紧急情况下，医师不在，护士可针对病情临时给予必要处理，但应做好记录并及时向经治医师报告。 二、有疑问医嘱 1、有疑问医嘱是指医嘱书写不清楚、医嘱书写有明显错误、医嘱内容违反治疗常规、药物使用规则、医嘱内容与日常医嘱内容有较大差别、医嘱有其他错误或者疑问。 2、当班护士在遇到疑问医嘱时，应向开出医嘱的医师提出，要求该医师重新核实无误，并由医师签字确认方可执行。
3、当班护士对开具的有疑问医嘱提出质疑，找不到开具医嘱的医师时，护士应当向该医师的上级医师或者科主任报告，直到该医嘱重新核实无误并有相关人员签字确认方可执行。 三、执行医嘱流程 常规流程：阅读-查对-确认-打印医嘱执行单-执行（操作前、操作中、操作后）-疗效及不良反应观察。 1、医嘱处理护士接医生下达的医嘱后，认真阅读及查对。 2、查对医嘱无质疑后确认医嘱。 3、电子医嘱要求护士校对、发送后由医师打印并及时签名。 ①医师签字要求： 长嘱：同一个时间的上下各签名一个，中间用尺子连线，线要直。 临嘱：同项目（如检查、口服药、液体等）同一时间上下各签名一个，中间用尺子连线，线要直。 ②护士签字要求： 长嘱：同一时间的上下各签名一个，中间用尺子连线，线要直，在时间与医嘱内容的分割线前打一红钩，停止医嘱时在停嘱时间与医师签字的分割线前打一红钩。 临嘱：同项目（如检查、口服药、同组液体等）严格按执行时间上下各签名一个，中间用尺子连线，线要直，在时间与临时医嘱的分割线前打一红钩。执行时间与签名同步。 4、医嘱处理护士按医嘱执行要求的缓急分配给护士执行。 5、医嘱执行护士接医嘱执行单后，认真查对，严格按照医嘱的内容、时间等要求准确执行，不得擅自更改。 6、医嘱执行后，应认真观察疗效与不良反应，必要时进行记录并及时与医生反馈。 四、口头医嘱制度与流程 1、在非抢救情况下，护士不执行抢救医嘱及电话通知的医嘱，