You are on page 1of 1

Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES


University Town, Northern Samar
Web: uep.edu.ph Email: ueppres06@gmail.com

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES


DRUG ANALYSIS
Name of Patient:____________________________ Date Admitted:_________ Chief Complaint:__________ Case Number:__________
Age:___ Gender:______ Civil Status:________ Address:____________________________ Ward:_____ AP:_______________________
NAME OF SPECIFIC INDICATION CONTRAINDICATIO DRUG ADVERSE SPECIFIC NURSING
DRUG ACTION N INTERACTION REACTION PRECAUTION RESPONSIBILITIES

Generic Name:

Brand Name:

Dosage:

Route:

Frequency:

Classification:

Reference:

You might also like