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STUDENT MED SHEET

Date:
Drug/Dosage Gen: Trade: Dosage: ORDERED DOSE: Route: by mouth IV IM Other: Tab Liq Suspn IVPB SC

* * * Pt. allergies:
Initials/Room #:
Classification Pt on it for:

Cap Liquid Drink IVPush ID

Inhaler

Time to give:

NOTES:

Drug/Dosage Gen: Trade: Dosage: ORDERED DOSE: Route: by mouth IV IM Other: Tab Liq Suspn IVPB SC Cap Liquid Drink IVPush ID Inhaler

Classification

Pt on it for:

Time to give:

NOTES:

Drug/Dosage Gen: Trade: Dosage: ORDERED DOSE: Route: by mouth IV IM Other: Tab Liq Suspn IVPB SC Cap Liquid Drink IVPush ID Inhaler

Classification

Pt on it for:

Time to give:

NOTES:

Drug/Dosage Gen: Trade: Dosage: ORDERED DOSE: Route: by mouth IV IM Other: Tab Liq Suspn IVPB SC Cap Liquid Drink IVPush ID Inhaler

Classification

Pt on it for:

Time to give:

NOTES:

Drug/Dosage Gen: Trade: Dosage: ORDERED DOSE: Route: by mouth IV IM Other: Tab Liq Suspn IVPB SC Cap Liquid Drink IVPush ID Inhaler

Classification

Pt on it for:

Time to give:

NOTES:

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