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ION MEDICAL CENTER

J. P. Rizal Extension, West Rembo, Makati City, 1215 Telephone


No.: (+632) – 881 – 1571

MEDICATION SHEET
NAME: Alleah AGE: 8 y/o HOSPITAL NO.: 112222 ‎‎‎‎‎‎‎‎‎‎

SERVICE: Pediatric SEX: Female WARD/RM: Room 1‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎


ATTENDING PHYSICIAN: Dr. Ga ‎‎‎‎‎‎‎‎‎‎ ‎‎‎

Hours
Medication Dosage ------ ------
of 09-21-22 09-22-22 09-23-22 Remarks
Route of Admin., frequency Adm. (Date) (Date)
(Date) (Date) (Date)

Paracetamol Tempra 250mg 8:00 am 8:00 am 8:00 am 8:00 am No allergies


(250mg/5ml) or 5ml PO Q4 12:00 pm 12:00 pm 12:00 pm 12:00 pm or adverse
4:00 pm effects noted
8:00 pm ------ ------
12:00 am
4:00 am

Ascorbic Acid Ceelin 200mg 8:00 am 8:00 am 8:00 am 8:00 am No allergies


(100mg/tab) or 2 tabs PO OD ------ ------ or adverse
effects noted

Nurse’s Date/ PRN, Stat, Nurse’s Date/ PRN, Stat,


Shift Shift
Signature Time Single Pre-Op Signature Time Single Pre-Op

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