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M Z 39 M M Dr Vencer

Surname First Name M.I. Age Sex Civil Status Admission No. Attending Physician

Sickle Cell Anemia MW4


Diagnosis Room/Ward
MEDICATION SHEET
Date Name of Medication DATE
Ordere (dose, route, frequency ) NO. OF DAYS
d 10-6 6-2 2-10 10-6 6-2 2-10 10-6 6-2 2-10 SHIFT

11/16/ Pentoxifylline (Trental), REMARKS


/
20
Oxycodone Acetaminophen /
(Percocet),
Hydroxyurea (Droxia) /
Folic Acid /

REMARKS

REMARKS

Nurse’s Complete Name Initials Nurse’s Complete Name Initials


JAN FEDERICK BANTAY SN JFLB
USLS

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