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POLICARPIO, INY JASMIN B. AYWNANUN , RARILEE S- PATIENTMEDICATION PROPIE ——__* PATIENTINGIAG SVC [ROOMNOs 421. DATE OF yNedecember 2, 3010 AGE $6 _|SEX! ALE WEIGHT: xo DATA | HEIGHT: No OATA | ALLERGY: Sea WORKING DIAGNOSIS: MI ;DIABETES T/C CAP P= Lei Pot Low salt, No SSS Se = TOR MOON aN Dae & Dare & e Date & ( \ Time Time of | Time [Name of Medication Dosa He Ordered} shnea | Eat XD iia ae inet Formin a | 1PM _| 11: 20Pm iyilos iE es eas T/L 12/5 (lepine FA SGA) 209m) 22.08, Sey, |shipted 12/5 Com) a5 Giiben clamide fo oD ] aioam | pease 2 aps _sAm_| 2 ie cues ais (I2TS ATS ‘Cipro rlonaein-€CCiprobey #8 Of Frequency Naan | Gam | !25¢m RN ec 12/5 (loam) 4 Taq tye $e ited» 216i | G@Am |GiAM |G loAM a Oe amy 2/4 PO oD wpm | 4:10pm pull WIS itis 1218 eipeplona cin Cepia obey aa Diacontinne 1278 | 14m | Gitsem| roam | te eter me Cea) ee webyrokl (eee) |\5omg Po aD am Sy Te | IEE 2 PO 0D am | wo i Ny po s Tay (12/3 fAsitheeng cin ‘som W 24 AL AS a ke : ae iv a7 “8 um Durale y0mg_—~« PO Bid [ibn [edt | 9TS°C (ene eae peace CAeknil) ip temp. 737) omg, . ~ oy a a a a ee 4 ee oe \ i ae ; ii . wr Nd MEDICATIONS Ta 1s Esomeprazole ee ny om WN ain 34m 3:30AM ‘ a/e /12/ Ra il . nam bom 2 Page Dots TV MEDICATIONS/IV INCORPORATIONS/PARENTERAL NUTRITIONS Sy % ‘Date & a Date & | Date & Time | Time | Tumeof Name of Medication Volume SY Remarks Ordered | Started ‘ian 4 73/1213 Shipted: 12/4 CaP) SAM | @: 10m ik 12/4 124 "Shipted 12 /7C1V AM) GPM | G30 PM 12/3 tH DENSS—+ 10a Bags —pp HEL oe H Dis continue! 1277 ~ Tat Lor (gam) wam | 4em me ee = KS fi : Page 3 of 3

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