DRUG STUDY

Name of Patient: ______________________________ Attending Physician: _______________________________

Age: ____________ Ward/Bed Number: ________________ Impression/Diagnosis: _____________________________

Dosage, Route,
Name of Drug Frequency and Mechanism of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing
Generic: Dosage:

Brand:
Route:

Classification Contraindications Side Effects

Functional: Frequency:

Chemical:
Timing:

Student’s Name: ___________________________________________________

Clinical Instructor: ___________________________________________________