DRUG STUDY GUIDE

NAME OF PATIENT: ___________________________________________ AGE: ____ SEX: ______________________Name of Student: _____________________________

CIVIL STATUS:______________RELIGION: ___________________________ RM/BED NO.________________________ Area: _______________Level / Block:_________
ADDRESS:____________________________________________________________________________________________ Date Submitted: ___________________________
DATE OF ADMISSION: __________________________________ DIAGNOSIS:__________________________________ Rating: __________________________________

CLASSIFICATION ADVERSE NURSING

MEDICATION INDICATIONS CONTRAINDICATIONS SIDE EFFECTS
/ ACTION EFFECTS RESPONSIBILITIES
Generic Name: Drug Class:

Brand Name:
Drug Action:
Usual
Dosage/Frequency
:

Usual Route:

Drug Order:

Peak of Action:

Onset of Action:

Half Life: