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UNIVERSITY OF CEBU – LAPULAPU AND MANDAUE

COLLEGE OF NURSING

DRUG STUDY

Patient: Age: Hospital No. Room No.


Impression / Diagnosis: Attending Physician (s):
Allergy to: None

Generic/ Brand Name Dose, Strength & Indication/ Mechanisms of Adverse/ Side Effects of Drug Nursing Responsibilities Rationale Client Teaching
& Formulation (10%) Drug Action Interaction (20%) (10%) (20%)
Classification (10%) (15%) (15%)
Timing: ADVERSE/ SIDE EFFECTS:
Generic: Indication:

Brand:

Duration: Mechanism of Action:


Classification:
.
DRUG INTERACTION:

Other Forms:

Printed Name and Signature Printed Name and Signature


Clinical Instructor
Student Note: Please provide additional sheet/s if necessary

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