PATIENT MEDICATION HISTORY

PATIENT: Nicka Hannah N. Fontanilla

2016
DATE OF BIRTH: 12-11-1995
WEIGHT: 60 kg

DATE:

02-09-

HEIGHT: 50

CURRENT PRESCRIPTION MEDICATIONS: Althea (Cyproterone acetate

2 mg, ethinyl estradiol 35 mcg); once a day for 21 days; started in January
2013; to regulate menstrual cycle.
PAST PRESCRIPTION MEDICATIONS: Provera (Medroxyprogesterone
acetate) 10 mg; once a day for 10 days; started in Jan. 2013; stopped in
Jan. 2013; for bleeding.
CURRENT NONPRESCRIPTION MEDICATIONS: None
PAST NONPRESCRIPTION MEDICATIONS: None
CURRENT COMPLEMENTARY AND ALTERNATIVE MEDICINES: None
PAST COMPLEMENTARY AND ALTERNATIVE MEDICINES: None
IMMUNIZATIONS: Polio vaccine, 1995 and Hepa B vaccine, 2015
ALLERGIES: Ibuprofen causes rashes; happened in 2004. Her Physicians
just changed her medication.
ADVERSE DRUG REACTION: None
SOCIAL HISTORY:
Dont smoke
Drinks alcohol lighlty
Dont use illicit drugs
Dont exercise regularly
Dont have hypertension and diabetes
Have genetic disease like heart disease
DIETARY INFORMATION:
Restrictions Sweets
Supplements None
Stimulants None
Suppressants None
ASSESSMENT OF PATIENT COMPLINCE: Compliant; go to her Physician
whenever needed or as ordered.
PHARMACIST: LAURENCE ANDRIE JAVONILLO ARTUZ