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SALAMAT HOSPITAL

DOCTOR`S ORDER
NAME : : ‫االسم‬ Patient File No.: : ‫رقم ملف المريض‬
Age : ‫العمر‬ SEX: M F : ‫الجنس‬ Dept.: : ‫ القسم‬ROOM: : ‫الغرفة‬
Nationality : :‫الجنسية‬ Attending Physician : : ‫الطبيب المعالج‬
Weight/BSA: Height: Pregnancy & Lactation: Allergies:

Diagnosis

TIME DOCTOR`S ACKNOWLEDGE


DATE DOCTOR`S ORDER SIGNATURE NURSE

PROHIBITED ABBREVIATION CORRECT USE


IU Unit
U or u Unit
QD or qd Daily
Zero after decimal point (e.g., 1.0mcg 1 mcg
Never use zeros after decimal
No zero before decimal point (e.g.,5mg) 0.5mg
Always use a zero before decimal
CC Ml
ug Mcg or microgram
D/C Discontinue plus the name of the drug or dis-
charge the patient
SH.MRD.F.023.01

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