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  • Nursing medication administration records

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    Charlie Abagon
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    med-ticket-for-RD(1)

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    14 views9 pages

    Nursing medication administration records

    Uploaded by

    Charlie Abagon

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 9

    Date: 4/29/21 Room: __________ Date: 4/28/21 Room:______

    Name: ____________________ Age: ___ Name: _________________ Age: ___


    Medicine: Isordil 5mg tablet__________ Medicine: Isordil 5mg tablet__________
    _____1 tablet______________________ ____1 tablet _____________________
    Time: stat__________________________ Time:stat_______________________
    Route: SL_________________________ Route: SL________________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-00 NSG – NSG -PO-01

    Date: _4/29/21_ Room: __________ Date: _4/28/21_ Room:______


    Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Guaifenesin 100mg/5ml syrup Medicine: Isordil 5mg tablet__________
    10 ml q 4 hours____________________ __________________________________
    Time: 6am-10am-2pm-6pm-10pm-2am Time:stat__________________________
    Route: PO_________________________ Route: SL________________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-02 NSG – NSG -PO-03

    Date: _4/28/21_ Room: __________ Date: _4/29/21_ Room:______


    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Guaifenesin 100mg/5ml syrup Medicine: Imdur 40mg tablet_______
    10 ml q 4 hours____________________ ____1 tab q 8 hours______________
    Time: 6am-10am-2pm-6pm-10pm-2am Time: 6pm-2am-10am___________
    Route: PO_________________________ Route: PO___________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-04 NSG – NSG -PO-05

    Date: _4/29/21_ Room: __________ Date: _4/28/21_ Room: __________


    Name: ____________________ Age: ___ Name: ________________ Age: ___
    Medicine: Imdur 40 mg tablet 1 tab_____ Medicine: Imdur 40 mg tablet 1 tab____
    ______q 8 hours____________________ ______q 8 hours_________________
    Time: 6am-2pm-10pm_______________ Time: 6am-2pm-10pm_______________
    Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-06 NSG – NSG -PO-07


    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Cefalexin 125mg/5ml_______ Medicine: Cefalexin 125mg/15ml______
    suspension 10 ml q 8 hours___________ suspension 10 ml q 8 hours___________
    Time: 6am-2pm-10pm_______________ Time: 6am-2pm-10pm_______________
    Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-08 NSG – NSG -PO-09

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________


    Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Acetaminophen 650mg tab 1 Medicine: Acetaminophen 650mg tab 1
    tab q 4 hours PRN for fever tab q 4 hours PRN for fever________
    Time: 6am-10am-2pm-6pm-10pm-2am_ Time: __________________________
    Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-010 NSG – NSG -PO-011

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________


    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: HGT monitoring TID AC_____ Medicine: HGT monitoring TID AC_____
    Time: 5am-11am-5pm______________ Time: 5am-11am-5pm______________
    Route: PO_______________________ Route: _________________________
    Signature over Printed Name: Signature over Printed Name:
    Monica Aguirre,RN ________________ Monica Aguirre,RN ________________

    NSG – NSG -PO-012 NSG – NSG -PO-013

    Date: 4/29/21 Room: __________ Date: 4/29/21 Room: __________


    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Captopril 25mg tablet Medicine: Captopril 25mg tablet
    _____1 tablet______________________ _____tablet____________________
    Time: stat__________________________ Time:stat__________________________
    Route: SL_________________________ Route: SL_________________________
    Signature over Printed Name: Signature over Printed Name:
    ___Karen Ebero,RN ____________ ___Karen Ebero,RN ____________

    NSG – NSG -PO-014 NSG – NSG -PO-015


    Date: 4/29/21 Room: __________ Date: 4/29/21 Room: __________
    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Captopril 25mg tablet Medicine: ABG_________________
    _____1 tablet______________________ _____________________________
    Time: stat__________________________ Time:stat__________________________
    Route: PO_________________________ Route: _______________________
    Signature over Printed Name: Signature over Printed Name:
    ___Karen Ebero,RN ____________ ___Karen Ebero,RN ____________

    NSG – NSG -PO-016 NSG – NSG -PO-017

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________


    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Cefexime 200mg/5ml susp Medicine: Cefixime 200mg/5ml susp
    10ml q 8 hours___________________ 10ml q 8 hours___________________
    Time: 6am-2pm-10pm-2am_ Time: 6am-2pm-10pm___________
    Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name:
    __Karen Ebero,RN ________________ __Karen Ebero,RN ________________

    NSG – NSG -PO-018 NSG – NSG -PO-019

    Date: _4/28/21_ Room: __________ Date: _4/29/21_ Room: __________


    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Cefixime 200mg/5ml susp Medicine: Cefexime 200mg/5ml susp
    10ml q 8 hours___________________ 10ml q 8 hours___________________
    Time: 6am-2pm-10pm______________ Time: 6am-2pm-10pm___________
    Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name:
    __Karen Ebero,RN ________________ __Karen Ebero,RN ________________

    NSG – NSG -PO-020 NSG – NSG -PO-021

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________


    Name: ____________________ Age: ___ Name: ___________________ Age: ___
    Medicine: Sulfamethoxazole 1 gram tablet Medicine: Sulfamethoxazole 1 g tablet 1
    1 tab TID_________________________ tab TID____________________
    Time: 6am-2nn-6pm______________ Time: 6am-12nn-6pm______________
    Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name:
    __Karen Ebero,RN ________________ __Karen Ebero,RN ________________

    NSG – NSG -PO-022 NSG – NSG -PO-023


    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/28/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Diphenhydramine Hcl Medicine: Diphenhydramine Hcl Medicine: Diphenhydramine Hcl
    12.5mg/5ml syrup 10ml q 6 hrs______ 125mg/5ml syrup 10ml q 6 hrs______ 12.5mg/5ml syrup 10ml q 6 hrs______
    Time: 6am-12nn-6pm-12mn_________ Time: 6am-12nn-6pm-12mn_________ Time: 6am-12nn-6pm-12mn_________
    Route: PO_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Karen Ebero,RN ________________ __Karen Ebero,RN ________________ __Karen Ebero,RN ________________

    NSG – NSG -PO-024 NSG – NSG -PO-025 NSG – NSG -PO-026

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Paracetamol 500 mg tab q 4 Medicine: Paracetamol 500 mg tab q 4 Medicine: Paracetamol 500 mg tab q 4
    hours PRN for fever________________ hours PRN for fever________________ hours PRN for fever________________
    Time: 6am-10am-2pm-6pm-10pm-2am____ Time: __________________________ Time: 6am-10am-2pm-6pm-10pm-2am_
    Route: PO_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Karen Ebero,RN ________________ __Karen Ebero,RN ________________ __Karen Ebero,RN ________________

    NSG – NSG -PO-027 NSG – NSG -PO-028 NSG – NSG -PO-029

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Metronidazole 250mg tablet 1 Medicine: Metronidazole 250mg tablet 1 Medicine: Metronidazole 250mg tablet 1
    cap QID__________________________ tab QID__________________________ tab QID__________________________
    Time: 6am-10am-2pm-6pm________ Time: 6am-12nn-6pm-10pm________ Time: 6am-10am-2pm-6pm________
    Route: PO_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________

    NSG – NSG -PO-030 NSG – NSG -PO-031 NSG – NSG -PO-032

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Motilium 1mg/ml suspension Medicine: Motilium 1mg/ml suspension Medicine: Dextrometorphan 100mg/5ml
    10ml q 8 hours___________________ 10ml q 8 hours___________________ syrup 5 ml q 6 hours_______________
    Time: 6am--2pm-10pm________ Time: 6pm—2am-10am________ Time: 6am-12nn-6pm-12mn________
    Route: PO_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________

    NSG – NSG -PO-033 NSG – NSG -PO-034 NSG – NSG -PO-035


    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Paracetamol 500 mg tab 1 tab Medicine: Paracetamol 500 mg tab 1 tab Medicine: Dextometorphan 100mg/5ml
    _______________________________ _______________________________ syrup 5 ml q 6 hours_______________
    Time: stat______________________ Time: stat______________________ Time: 6am-12nn-6pm-12mn________
    Route: PO_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________

    NSG – NSG -PO-036 NSG – NSG -PO-037 NSG – NSG -PO-038

    Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Simethicone 40mg/0.6 ml Medicine: Simethicone 40mg/0.6 ml susp. Medicine: Simeticone 40mg/0.6 ml susp.
    suspension 0.6 ml q 4 hrs PRN for flatulence 0.6 ml q 4 hrs PRN for flatulence 0.6 ml q 4 hrs PRN for flatulence
    Time: 6am-10am-2pm-6pm-10pm-2am__ Time: ___________________________ Time: 6am-10am-2pm-6pm-10pm-2am__
    Route: PO_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________

    NSG – NSG -PO-039 NSG – NSG -PO-040 NSG – NSG -PO-041

    Date: _4/14/21_ Room: __________ Date: _4/14/21_ Room: __________ Date: _4/29/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Tazocin 4.5 grams q 6 hours Medicine: Co-amoxiclav 400mg/57mg/5ml Medicine: Co-amoxiclav 400mg/57mg/5ml
    _________________________________ suspension 5 ml TID________________ suspension 5 ml TID________________
    Time: 6am-12nn-6pm-12mn________ Time: _6am-12nn-6pm____________ Time: _6am-12nn-6pm____________
    Route: IV_________________________ Route: PO_________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Bella Shary Fuentes,RN _________ __Bella Shary Fuentes,RN __________ __Bella Shary Fuentes,RN ___________

    NSG – NSG -PO-042 NSG – NSG -PO-043 NSG – NSG -PO-044

    Date: _4/14/21_ Room: __________ Date: _4/29/21_ Room: __________ Date: _4/14/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: IdegAspart 20 units q 12 hrs AC Medicine: IdegAspart 20 units q 12 hrs AC Medicine: Calci-aid 500mg tablet 1 tab
    _________________________________ _________________________________ BID_________________________
    Time: 5am-5pm__________________ Time: 5am-5pm__________________ Time: _6am-6pm____________
    Route: SC________________________ Route: SC________________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN ___________

    NSG – NSG -PO-045 NSG – NSG -PO-046 NSG – NSG -PO-047


    Date: _4/14/21_ Room: __________ Date: _4/14/21_ Room: __________ Date: _4/14/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Paracetamol 500 mg tab 1 tab Medicine: Paracetamol 500 mg tab 1 tab Medicine: Calci-aid 500mg tablet 1 tab
    _______________________________ _______________________________ BID_________________________
    Time: stat__________________ Time: stat__________________ Time: _10am-6pm____________
    Route: PO______________________ Route: PO______________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN ___________

    NSG – NSG -PO-048 NSG – NSG -PO-049 NSG – NSG -PO-050

    Date: _4/14/21_ Room: __________ Date: _4/14/21_ Room: __________ Date: _4/14/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Cetirizine+Phenylephrine Hcl Medicine: Cetirizine Hcl 5mg/5ml syrup 10 Medicine: Calci-aid 500mg tablet 1 tab
    5mg/5ml syrup 10 ml q 6 hours_______ ml q 6 hours_______ BID_________________________
    Time: 6am-12nn-6pm-12mn_________ Time: 6am-12nn-6pm-12mn_________ Time: _6am-6pm____________
    Route: PO______________________ Route: PO______________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN ___________

    NSG – NSG -PO-051 NSG – NSG -PO-052 NSG – NSG -PO-053

    Date: _4/14/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: CBG TID AC Medicine: Levothyroxine 50 mcg 1 tab OD Medicine: Levothyroxine 50 mg tab 1 tab
    Time: 5am-11am-5pm_________ AC_______________________________ OD AC__________________________
    Route: PO______________________ Time: 6am_________ Time: _5am_____________________
    Signature over Printed Name: Route: PO______________________ Route: PO_________________________
    __Bella Shary Fuentes,RN _____________ Signature over Printed Name: Signature over Printed Name:
    __Monica Aguirre,RN _____________ __Monica Aguirre,RN ___________
    NSG – NSG -PO-054
    NSG – NSG -PO-055 NSG – NSG -PO-056

    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Diphenhydramine HCl Medicine: Diphenhydramine HCl Medicine: Levothyroxine 50 mcg tab 1 tab
    12.5mg/5ml syrup 10ml q 6 hours_____ 12.5mg/5ml syrup 10ml q 6 hours_____ OD AC__________________________
    Time: 6am-12mn-6pm-12mn________ Time: 6am-12nn-6pm-12mn________ Time: _5am_____________________
    Route: PO______________________ Route: PO______________________ Route: PO_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________ __Monica Aguirre,RN ___________

    NSG – NSG -PO-057 NSG – NSG -PO-058 NSG – NSG -PO-059


    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Diphenhydramine 12.5mg/5ml Medicine: Calci-aid 500mg tablet 1 tab q Medicine: Calci-aid 500mg tablet 1 tab q
    syrup 10ml q 6 hours_____ 12 hours_______________________ 12 hours_______________________
    Time: 6am-12nn-6pm-12mn________ Time: 6am-6pm________________ Time: 12nn-12mn________________
    Route: PO______________________ Route: PO______________________ Route: PO______________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________

    NSG – NSG -PO-060 NSG – NSG -PO-061 NSG – NSG -PO-062

    Date: _4/26/21_ Room: __________ Date: _4/28/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Ranitidine 300mg tab_1 tab__ Medicine: Calci-aid 500mg tablet 1 tab q Medicine: Ranitidine 300mg tab___
    Time: stat_________________ 12 hours_______________________ 2 tabs_________________________
    Route: PO______________________ Time: 6am-6pm________________ Time: stat_________________
    Signature over Printed Name: Route: PO______________________ Route: PO______________________
    __Monica Aguirre,RN _____________ Signature over Printed Name: Signature over Printed Name:
    __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________
    NSG – NSG -PO-063
    NSG – NSG -PO-064 NSG – NSG -PO-065

    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Cefixime 200mg/5ml suspension Medicine: Cefixime 200mg/5ml Medicine: Cefixime 200mg/ml suspension
    10 ml q 8 hours____________________ suspension 10 ml q 8 hours______ 10 ml q 8 hours__________________
    Time: 6am-12nn-6pm_____________ Time: 6am-2pm-10pm_____________ Time: 6am-2pm-10pm_____________
    Route: PO______________________ Route: PO______________________ Route: PO______________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________

    NSG – NSG -PO-066 NSG – NSG -PO-067 NSG – NSG -PO-068

    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/28/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Paracetamol 500mg tablet q 4 Medicine: Paracetamol 500mg tablet q 4 Medicine: Paracetamol 500mg tablet q 4
    hours PRN for fever______________ hours PRN for fever______________ hours _________________________
    Time: 6am-10am-2pm-6pm-10pm-2am__ Time: ________________________ Time: 6am-10am-2pm-6pm-10pm-2am__
    Route: PO______________________ Route: PO______________________ Route: PO______________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________ __Monica Aguirre,RN _____________

    NSG – NSG -PO-069 NSG – NSG -PO-070 NSG – NSG -PO-071


    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Febuxostat 40 mg tablet 1 tab Medicine: Febuxostat 40 mg tablet 1 tab Medicine: Febuxostat 40 mg tablet 1 tab
    OD AC__________________________ OD AC__________________________ OD AC__________________________
    Time: 6am______________________ Time: 5am______________________ Time: 7 am______________________
    Route: PO_______________________ Route: PO_______________________ Route: PO_______________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN _____________ __Bella Shary Fuentes,RN _____________

    NSG – NSG -PO-072 NSG – NSG -PO-073 NSG – NSG -PO-074

    Date: _4/29/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Arcoxia 30 mg tab 1 tab Medicine: Arcoxia 30mg tablet 1 tab Medicine: Arcoxia 30mg tablet 1 tab
    _______________________________ Time: stat______________________ Time: stat______________________
    Time: stat______________________ Route: PO_________________________ Route: SC_________________________
    Route: PO_________________________ Signature over Printed Name: Signature over Printed Name:
    Signature over Printed Name: __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________
    __Mae Zarsona,RN ________________
    NSG – NSG -PO-076 NSG – NSG -PO-077
    NSG – NSG -PO-075

    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Amoxicillin 250mg/5ml Medicine: Amoxicillin 250mg/5ml Medicine: Amoxicillin 250mg/5ml
    suspension 10ml TID_____________ suspension 10ml TID_____________ suspension 10ml TID______________
    Time: 6am-12nn-6pm-12mn_________ Time: 6am-12nn-6pm_________ Time: 6am-12nn-6pm_________
    Route: PO_________________________ Route: PO_________________________ Route:_________________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Karen Ebero,RN ________________ __Karen Ebero,RN ________________ __Karen Ebero,RN ________________

    NSG – NSG -PO-078 NSG – NSG -PO-079 NSG – NSG -PO-080

    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room: __________
    Name: ____________________ Age: ___ Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Plemex Forte 600mg/ml syrup Medicine: Plemex Forte 600mg/5ml syrup Medicine: Paracetamol 500mg tablet 1 tab
    5 ml TID____________________ 5 ml TID____________________ q 4 hours _________________________
    Time: 6am-12nn-6pm_________ Time: 6am-12nn-6pm_________ Time: 6am-10am-2pm-6pm-10pm-2am__
    Route: PO_________________________ Route: PO_________________________ Route: PO______________________
    Signature over Printed Name: Signature over Printed Name: Signature over Printed Name:
    __Mae Zarsona,RN ________________ __Mae Zarsona,RN ________________ __Mae Zarsona,RN _____________

    NSG – NSG -PO-081 NSG – NSG -PO-082 NSG – NSG -PO-083


    Date: _4/26/21_ Room: __________ Date: _4/26/21_ Room:______
    Name: ____________________ Age: ___ Name: ____________________ Age: ___
    Medicine: Paracetamol 500mg tablet 1 Medicine: CBG TID AC__________
    tab q 4 hours ________________ __________________________________
    Time: 6am-10am-2am-6pm-10pm-2am__ Time: 5am-11am-5pm__________
    Route: PO______________________ Route: _________________________
    Signature over Printed Name: Signature over Printed Name:
    __Mae Zarsona,RN _____________ Mae Zarsona,RN ________________

    NSG – NSG -PO-084 NSG – NSG -PO-085

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