A616, Academic Year 20-21

ACTIVITY ON ASSESSMENT AND PHARMACEUTICAL CARE

OBJECTIVES:

At the end of the activity, the student should be able to:

1. Accomplish a sample of pharmaceutical care plan using information coming from the
patient’s prescription, laboratory and diagnostic results
2. Conduct interview to patient regarding medical condition and a registered pharmacist
regarding the problem encountered by patient while conducting the said activity.
3. Perform the vital signs to the chosen patient.

GUIDELINES:

1. The Pharmaceutical care plan distributed is a simple sample of pharmaceutical care plan for a BS
Pharmacy First-year student who is now taking PHA616, Introductory to Healthcare System
under my tutelage.
2. Choose one relative to take care for a week.
3. Get his/her medical documents such as prescription and laboratory/diagnostic results to be
used in accomplishing information on the pharmaceutical care plan specifically on rationale.
4. Interview the patient in order to accomplish completely the pharmaceutical care plan. You may
also ask a pharmacist or search some of the possible solution regarding the problem
encountered by the patient.
5. Attached proof of documentation such as pictures, prescription, laboratory /diagnostic test
results and send in a pdf file format.
6. Submission: April 6,2021 Tuesday on the submission portal created for this activity.
PHARMACEUTICAL CARE PLAN

Patient ‘s Name:_______________________ Age: ______ Weight: _____ Gender:_____

Address:______________________________________________________________________________
Contact no.:________________

PRESENTING COMPLAINT PAST/MEDICAL HISTORY

RISK FACTOR, SOCIAL/FAMILY HISTORY ALLERGY STATUS

IMMUNIZATION No. of Cigarettes/day

No. of bottle of alcohol /day

DRUG HISTORY

DRUG DOSE/FREQUENCY INDICATION RATIONALE

MAIN DIAGNOSIS: __________________________

MAIN DIAGNOSIS PROBLEM LIST

PROBLEM DESIRED OUTCOME/GOAL OF TREATMENT OPTION

TREATMENT
DAILY ROUTINE MONITORING:

DATE TEMPERATURE PULSE RATE RESPIRATORY Blood GLUCOSE

RATE Pressure LEVEL

Glucose monitoring is for diabetic patient. Write “NA” if not applicable

Pharmacist:

_______________________________

( Signature over printed Student’s Name)

Department :

__________________________

(Year & Section)

A T T A C H M E N T : DOCUMENTATION