UNIVERSITY OF CEBU - BANILAD

College of Nursing

DRUG STUDY
Patient: ___________________________________________________________________________________ Age: ________________ Hospital No.:__________Room No.:___________________
Impression/Diagnosis: _______________________________________________________________________ Attending Physicians: _____________________________________________________
Allergy to: _________________________________________________________________________________

Generic / Brand Name & Dose, Strength & Indications/Mechanisms of Adverse/Side Effects
Nursing Responsibilities Rationale Client Teaching
Classification Formulation Drug Action Drug Interaction

Generic: Ordered: Indications:

Brand: Timing:

Classification: Duration: Mechanism of Action:

Other forms:

Printed Name and Signature: Printed Name and Signature:

Clinical Instructor: Student/s:

Note: Please provide additional sheet/s if necessary.