Notre Dame of Jolo College

JOLO 7400 SULU, PHILIPPINES

Health Sciences Department

DRUG STUDY

Name of Patient:___________________________________________ Age:____________ Diagnosis:__________________________________________

CLASSIFICATION INDICATION SIDE EFFECT NURSING RESPONSIBILITY

Name of student:_______________________________________________________ year & sec:_________________ Group:______________________________________

Clinical Instructor: ________________________________________________________

 SAMPLE
MEDICATION CLASSIFICATION INDICATION SIDE EFFECT NURSING
RESPONSIBILITY
Generic name:
____________
Brand name:
____________
Dosage:
_____________
Route:
_____________
Frequency:
__________

(include drawing of
the medication)

Name of student:_______________________________________________________ year & sec:_________________ Group:______________________________________

Clinical Instructor: ________________________________________________________