You are on page 1of 2

University of Iloilo - PEN

College of Nursing

DRUG STUDY

Name of Patient:
Physician:

Ward/Bed Number:

Age:

Attending

Chief Complaint:

Impression/Diagnosis:

Dosage,
Name of Drug

Route,

Mechanism of

Frequency,

Action

Indication

Adverse

Special

Nursing

Reactions

Precautions

Responsibilities

Timing
Generic:

Dosage:

Brand:

Route:
Classification
Functional:

Frequency:

Chemical:
Timing:

Contraindicatio
n

Side Effects

Students Name:

Clinical Instructor:

You might also like