Medication Passport

Faculty will sign students off on medications given to a patient (Pt), reviewed in virtual clinical scenarios (vSim), or presented in
clinical conference (CC), assuring that the student understands the aspects of the medication listed below and found on the
medication drug card template by placing a check mark in each box and signing and dating in the last column.

Clinical Student Please Complete Student Please Complete Faculty Place Check Mark If Context Please Date and Sign
Site Student Correctly Explained
These Components of the Drug
Card

Adverse Effects
cMechanism Of Action

Therapeutic Use

Patient Education
mPharmacologic Class

Dosages/Routes

Nursing Considerations
Interactions
Patient (P) Date and Signature
Clinical

Contraindications
Conference
(CC)
Dosage/Route of
Drug
Administration vSim (V)

MOST COMMON
DRUGS for Specialty
Other Drugs or
Drugs Administered