Drug – drug Interaction Checker (list as many as possible)

Drug A Drug B Interaction Effect Level of Risk

(Y/N)? (High,Moderate,Low)

Drug – disease Interaction Checker (list as many as possible)

Disease/condition/morbidity Drug Interaction Effect Level of Risk
(Y/N)? (High,Moderate,Low)

Recommendation: use Medscape

Patient Presentation Is there Details (leave blank if N)

info on Note: only info that indicates presence of HF and type of HF. Do not copy paste
HF? (Y/N) everything.
Chief Complaint
HPI
PMH
FH
SH
Meds
All
ROS
Gen
VS
Skin
HEENT
Neck
Lungs/Thorax
Heart
Abd
Genit/Rect
MS/Ext
Neuro
 Labs
ECG
Chest X-Ray
Echocardiogram

Patient’s Problems (list as many Relation to drug therapy (Explain/rationalize)

as possible)

Goals (list as many as possible) Pharmacologic therapy How to assess if the intervention is
working? (VS,Labs,others)
#1
#2
#3

Medication with Route Dose Schedule Duration of Therapy

Note: List as many as possible

Create a SCRIPT on what exactly you will say to the patient. Here is a checklist on what is necessary to include when you
educate the patient. You can add more beyond the checklist.

Checklist for Patient Education:

1. Generic and brand names of the medication.

2. Purpose of the medication.
3. Dosage and how to take the medication.
4. What to do if a dose is missed.
5. Duration of therapy.
6. Minor side effects and what to do if they occur.
7. Serious side effects and what to do if they occur.
8. Medications to avoid.
9. Foods to avoid and other precautions.
10. How to store the medications.
11. Follow-up care. Anyone taking medication requires ongoing care to assess effectiveness and appropriateness of
medications. Many medications require invasive and noninvasive testing to monitor blood levels; hematopoietic, hepatic, or
renal function; or other effects on other body systems. Ongoing medical evaluation may result in dosage adjustments, change
in medication, or discontinuation of medication.
12. What not to take.

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