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NAME OF STUDENT: Noveno, Jamaica Leslie M.

– N4A Group 3

MEDICATION/TREATMENT ADMINISTRATION RECORD


L4-NSD-030 Rev 00

LAST NAME FIRST NAME MIDDLE NAME

DELA CRUZ JUAN RIZAL

ATTENDING PHYSICIAN DATE OF BIRTH (mm/dd/year) AGE SEX

Dr. Soliman 06/19/1989 32 M

ROOM# BED # HOSP # CIVIL STATUS

403 _______ 06132013 ___________

Date
Name, Dosage, Frequency, Route Date/Time 1/17 1/18 1/19
Ordered

1/17 Azithromyzin 500 mg / tab OD 8 am Jamaica Jamaica Jamaica

3 days Dose
completed
Jamaica 1/19
J.Noveno
Lic.
180065710
Kalium Durule 1-tab TID 8 am Jamaica Jamaica
6 doses 1 pm Jamaica Jamaica
6 pm Jamaica Jamaica Dose
completed
Jamaica 1/18
J.Noveno
Lic. 180065710
Paracetamol 500mg 1 tab PRN
q4h for fever

Specimen Signature
Signature Shift Nurse-on-Duty
6-2 Jamaica Leslie Noveno

TREATMENT ADMINISTRATION RECORD


Date Name, Dosage, Frequency, Route Date/Time
NAME OF STUDENT: Noveno, Jamaica Leslie M. – N4A Group 3

MEDICATION/TREATMENT ADMINISTRATION RECORD


L4-NSD-030 Rev 00

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