Students Name: _________________________________

Patients Name: _________________________ RM#: ________

Medications: Time: IV Fluid: _________ gtts/min: _________ Infusion/hr.:__________

1. _______________ _______ 3- ______ 8- ______ Level Received: ________

2. _______________ _______ 4- ______ 9- ______ Level Endorsed: ________
3. _______________ _______ 5- ______ 10- ______
4. _______________ _______ 6- ______ 11- ______
5. _______________ _______ 7- ______

Students Name: _________________________________

Patients Name: _________________________ RM#: ________

Medications: Time: IV Fluid: _________ gtts/min: _________ Infusion/hr.: __________

1. _______________ _______ 3- ______ 8- ______ Level Received: ________

2. _______________ _______ 4- ______ 9- ______ Level Endorsed: ________
3. _______________ _______ 5- ______ 10- ______
4. _______________ _______ 6- ______ 11- ______
5. _______________ _______ 7- ______

Students Name: _________________________________

Patients Name: _________________________ RM#: ________

Medications: Time: IV Fluid: _________ gtts/min: _________ Infusion/hr.: __________

1. _______________ _______ 3- ______ 8- ______ Level Received: ________

2. _______________ _______ 4- ______ 9- ______ Level Endorsed: ________
3. _______________ _______ 5- ______ 10- ______
4. _______________ _______ 6- ______ 11- ______
5. _______________ _______ 7- ______

Students Name: _________________________________

Patients Name: _________________________ RM#: ________

Medications: Time: IV Fluid: _________ gtts/min: _________ Infusion/hr.: __________

1. _______________ _______ 3- ______ 8- ______ Level Received: ________

2. _______________ _______ 4- ______ 9- ______ Level Endorsed: ________
3. _______________ _______ 5- ______ 10- ______
4. _______________ _______ 6- ______ 11- ______
5. _______________ _______ 7- ______

Students Name: _________________________________

Patients Name: _________________________ RM#: ________

Medications: Time: IV Fluid: _________ gtts/min: _________ Infusion/hr.: __________

1. _______________ _______ 3- ______ 8- ______ Level Received: ________

2. _______________ _______ 4- ______ 9- ______ Level Endorsed: ________
3. _______________ _______ 5- ______ 10- ______
4. _______________ _______ 6- ______ 11- ______
5. _______________ _______ 7- ______

STUDENT ASSIGNMENT SHEET: