ILLINOIS CENTRAL COLLEGE

PRNRS 111 Clinical

Medication Summary, Reason & Response Sheet

Student:
Date:
Patient Initials:

List each prescribed Dose, route, Explain the Actual assessment -Side Effects (most common)
medication frequency ACTUAL reason data of specific -Nursing Implications
 generic and ordered this patient is patient responses
brand name receiving each to each medication
 classification medicine
 sub-classification
S/E
N/I

(Hit “TAB” to create more rows as need be!)

Revised TP 2017