Discharge Home Instructions

Medication
Quantity Start/ Remarks / Special
Last Instructions /
Generic Name Brand Name Per Take / Frequency Next
Route Dose Suggested Time
Dose
TAKE 1 TABLET
FEB. MAR. TWICE A DAY
24 02 EVERY 12 HOURS AT
EPERISONE 1 TABLET
(I) MYONAL 50MG TAB TWICE A DAY 2023 2023 8AM-8PM FOR 7
HYDROCHLORIDE (ORAL)
08:00 AM 08:00 AM DAYS

LAST DOSE 3/2/2023

TAKE 1 TABLET
FEB. MAR. TWICE A DAY
24 02 EVERY AT 10AM-
1 TABLET
PREGABALIN FUNXION 50MG CAP TWICE A DAY 2023 2023 10PM FOR 7 DAYS
(ORAL)
10:00 AM 10:00 AM
LAST DOSE 3/2/2023
10AM
TAKE 1 TABLET
FEB. FEB. TWICE A DAY
24 26 EVERY 8AM-8PM
(I) CELEBREX 100MG 1 TABLET
CELECOXIB TWICE A DAY 2023 2023 FOR 3 DAYS ONLY
CAP (ORAL)
08:00 AM 08:00 AM
LAST DOSE 2/26/2023
8AM
FEB. UNTIL
24 FOLLOW-UP TAKE 2 TABS BY
2 TABS CONSUL-
CARVEDILOL (A) CARVID 6.25MG TAB ONCE A DAY 2023 TATION IS MOUTH ONCE DAILY
(ORAL)
08:00 AM MADE / EVERY 8AM
DONE

1 DROP FEB. UNTIL

BOTH 23 FOLLOW-UP 1 DROP ON BOTH EYES 5
SPECIAL CONSUL-
SANCOBA EYEDROPS EYES 2023 TATION IS
TIMES DAILY (8AM-12NN-
FREQUENCY 4PM-8PM-10PM)
(OPHTHA 10:00 PM MADE /
DONE
LMIC)
FEB. UNTIL APPLY AMPLE
AMPLE 24 FOLLOW-UP AMOUNT ON FACE
(I) CETAPHIL LOTION CONSUL-
AMOUNT TWICE A DAY 2023 TATION IS AND WHOLE BODY
237 ML BOT
(TOPICAL) 08:00 PM MADE / TWICE DAILY AFTER
DONE
BATH
FEB. UNTIL
APPLY AMPLE
KETOCONAZOLE AMPLE 24 FOLLOW-UP
CONSUL- AMOUNT AS
(DERMAZOLE) AMOUNT EVERY BEDTIME 2023 TATION IS SHAMPOO EVERY
SHAMPOO (TOPICAL) 10:00 PM MADE /
DONE BEDTIME
FEB. UNTIL APPLY AMPLE
AMPLE FOLLOW-UP
BETAMETHASONE 24 AMOUNT ON SCALP
AMOUNT TWICE A DAY CONSUL-
VALERATE 2023 TATION IS AREA TWICE DAILY
(TOPICAL) MADE /
(BETNOVATE) 08:00 EVERY 8AM-8PM

2208 123 270

NICOLAS, Visitacion Urmatam Gender: Female

Birthdate: Jul 02, 1982 (40 year/s)
Room/Bed: 3200A-3200A Admitting Doctor: PASOL, ESTEBAN ANABO
Admission Date: Feb 21, 2023 11:08 AM Nurse: ESTA, KHIRSTIE RUTH SANDICO

279 E. Rodriguez Sr. Blvd., Quezon City * Tel. No.: (632) 723-0101 / 723-0301
 APPLY AMPLE
AMPLE
BETAMETHASONE AMOUNT ON SCALP
AMOUNT TWICE A DAY AM DONE
VALERATE AREA TWICE DAILY
(TOPICAL)
(BETNOVATE) EVERY 8AM-8PM
FEB. UNTIL
1 DROP 24 FOLLOW-UP
CONSUL- 1 DROP TO BOTH
HYABAK EYEDROPS (OPHTHA AS NECESSARY 2023 TATION IS EYES AS NEEDED
LMIC) 08:00 AM MADE /
DONE

REMINDER: FOR SAFETY REASONS, PARTIALLY OPENED, DISCONTINUED, AND UNUSED MEDICINES THAT ARE NOT PART
OF THE HOME MEDICATION WILL NOT BE ISSUED UPON DISCHARGE.

Activity
OPTHALMOLOGY
- FOLLOW UP WITH DR. JIMENEZ AFTER 1 WEEK VIA TELECONSULT

NEUROLOGY
- FOR CRANIAL MRI WITH CONTRAST, BUN, CREA AS OUTPATIENT
- FOLLOW UP ONCE WITH CRANIAL MRI WITH CONTRAST RESULT

Appointment
Doctor Name Specialization Clinic Schedule / Location / Appointment Date
PASOL, ESTEBAN ANABO NEUROLOGY M;11:00 AM - 01:00 PM W;10:00 AM -
12:00 PM F;09:00 AM - 11:00 AM /
10TH FLOOR (1017) / 8-723-0101
L5017
JIMENEZ, JOSE MELVIN OPHTHALMOLOGY MWTHF 9-12NN T 1-4PM / 11TH
BUENAFLOR FLOOR (1108) / 8-7230101 L5108

ENCARNACION, LONABEL DERMATOLOGY TTHUS 10-4pm by appointment / 4TH

ANCHETA FLOOR (428) / 726-36-68
BERMUDEZ, CHARITO RHEUMATOLOGY TTHS 9-12nn / 5TH FLOOR (526) / 8-
CRUZ 7230101 L6526

FOR NURSE / CLINICAL PHARMACIST FOR PATIENT / RELATIVE :

Verified Instruction Received
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

Instructed Medications Received

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

NOTE: KINDLY CALL YOUR DOCTOR'S CLINIC TO CONFIRM YOUR SCHEDULE PRIOR TO YOUR APPOINTMENT.

2208 123 270

NICOLAS, Visitacion Urmatam Gender: Female

Birthdate: Jul 02, 1982 (40 year/s)
Room/Bed: 3200A-3200A Admitting Doctor: PASOL, ESTEBAN ANABO
Admission Date: Feb 21, 2023 11:08 AM Nurse: ESTA, KHIRSTIE RUTH SANDICO

279 E. Rodriguez Sr. Blvd., Quezon City * Tel. No.: (632) 723-0101 / 723-0301
 February 23, 2023 | 2138 HRS February 23, 2023 | 2138 HRS

PIN 2208123270 Age 40 PIN 2208123270 Age 40

Name NICOLAS, Visitacion Urmatam Name NICOLAS, Visitacion Urmatam
Address 16 DACALLAFUGU, CAMALANUIGAN, CAGAYAN VALLEY Address 16 DACALLAFUGU, CAMALANUIGAN, CAGAYAN VALLEY
PHILIPPINES 3510 PHILIPPINES 3510

Generic Name: Generic Name:

CARVEDILOL

Brand Name: Brand Name:

SANCOBA EYEDROPS #1 (A) CARVID 6.25MG TAB #30

Sig: Sig:
1 DROP BOTH EYES, SPECIAL FREQUENCY, 2 TABS, ONCE A DAY, ORAL
OPHTHALMIC

Brand Name:
Brand Name:
KETOCONAZOLE (DERMAZOLE) SHAMPOO #1
HYABAK EYEDROPS #1

Sig:
Sig:
AMPLE AMOUNT, EVERY BEDTIME, TOPICAL
1 DROP, AS NECESSARY, OPHTHALMIC

PASOL, ESTEBAN ANABO PASOL, ESTEBAN ANABO

Signature Signature
License: #0082680 License: #0082680
 February 23, 2023 | 1821 HRS February 23, 2023 | 1821 HRS

PIN 2208123270 Age 40 PIN 2208123270 Age 40

Name NICOLAS, Visitacion Urmatam Name NICOLAS, Visitacion Urmatam
Address 16 DACALLAFUGU, CAMALANUIGAN, CAGAYAN VALLEY Address 16 DACALLAFUGU, CAMALANUIGAN, CAGAYAN VALLEY
PHILIPPINES 3510 PHILIPPINES 3510

Generic Name: Generic Name:

EPERISONE HYDROCHLORIDE CELECOXIB

Brand Name: Brand Name:

(I) MYONAL 50MG TAB #13 (I) CELEBREX 100MG CAP #6

Sig: Sig:
1 TABLET, TWICE A DAY , ORAL 1 TABLET, TWICE A DAY , ORAL

Generic Name:
PREGABALIN

Brand Name: Brand Name:

(I) CETAPHIL LOTION 237 ML BOT #1 FUNXION 50MG CAP #13

Sig: Sig:
AMPLE AMOUNT, TWICE A DAY , TOPICAL 1 TABLET, TWICE A DAY , ORAL

PASOL, ESTEBAN ANABO PASOL, ESTEBAN ANABO

Signature Signature
License: #0082680 License: #0082680
 February 23, 2023 | 2138 HRS

PIN 2208123270 Age 40

Name NICOLAS, Visitacion Urmatam
Address 16 DACALLAFUGU, CAMALANUIGAN, CAGAYAN VALLEY
PHILIPPINES 3510

Generic Name:

Brand Name:
BETAMETHASONE VALERATE (BETNOVATE) #1

Sig:
AMPLE AMOUNT, TWICE A DAY , TOPICAL

PASOL, ESTEBAN ANABO

Signature
License: #0082680