Professional Documents
Culture Documents
a
Itii
sloxagearain he hoshilal s Jthe
m
batients bedsiie
ar
Mhods odiug_disibution or
Ph in lalien
inpatin
duugoY
hea ousulems o ovdey Jym
dis penaing
undiyicluolrediption
LCompleteloAY,Slorh uslem
Combination_on &
mehod
) he Lnit dose
l
oxder slem
el
ng OLon_Lhayqri
re
antogs
ThoYides lhe inlxalion.o bhamauiat-
dociox,nuxiand hebiint.
dicaiian grder.s a dily
xeviuOLd
Ca
þhaymaÍsls
Date
Only Lom.monly tulecd druqsal slaped onthe
a
uanloas
m
Rdud
Mnimy m
in-lind OAipiion
Yiun_ of clu
ors
h dug a adily euailable ox acdminiilhalbmn
The dou
ar
l Ph
el
a
uehe
oicrylim 0s Pimay mtanA dasonin
dtsptnsing
limitcdlooslocs
m
UHR
)nit bieSusitm.
medicetion
uhiuh a oudrd pathagd"
ar
-Tha haxqtcl in
handtd, adminaltnd_and
mullible singe daeUnii
pbly uCLentor ont Lqular do
Ph
aobleaioh o us
Handoas
poatien bhaymactuiial stviLe housz
utiye
he only dugs uuhith
l
aQreday and ae_haxg.edo
adminisied obim. tquiTtd
el
H dosJtS medizaion
lhe at
nune.
nuxsingstalign_whiuh_qlloos he
morelme. oy dirut balient taJ.
w
promoi
n uiliadion
dnd non_Pio-RssionalDisonntl
ni Dose Dispensing {yatdux.
Ca
a
he _hau
haiging o dxuas Hn_quijaole. ,
m
du aulg pcharasd qllcale4oifis
AEnlandifshoufd_he tp imind
polehaupial he nanialinluui1s
ar
hesbolkctes lon b (ale'goxsed under ifueiq
Syslemsfhe
AL ndusive o D aleial Ph xale
Chasas abau250 paient qesludied
hiY o saq
daily_cha4esodYu(s_and
bharmaLedital suiLes is taleulalee.
12) A Dot -incluive
l
ol.
el
Bstah -tven_point
itu
sANal analsi
as Th
o0uplume
plume elalionh
1tlaoliond
s deljined
isdeljintd0s Ihe l ot whith shex is
ncithiyao OYOSS
Page No..
Date
a
Cat-plu rale slm
m
Tt helps in adjuiment Lost luciuaion.
&Hexene
alyh
Ín_uxnLyNalut ingnlia quiemen
ar
ofasantas dod aipialondpalitnis
The Rot Apd
Ph
In his biot s faleulaled, ino bike la th
pen DsesCpiion
otient by d
l
el
Combutaized icin-
w
sovid Compuloraedonlinephaxmaryiinq-
1
ollooing inoYmaifon_i
re
the Lonuhtl
a
hbashilaphoxmoaythe
In haupilal bxLDAt
Oqng lhsall oltolai
m
he disphy
hospilals
PL
In-Osmolion_
on
abot_aiodui iisal nokntpat laaing
hebxodu
caxya label dh
ar
ahpataaggshould
ddpilad oxmolion.-
mxp bblingmmypxOidle insu |
10-0Y malion_on he&hL
Ph
Th batein o labul is as undtx
LNamet
2bsag Josm
3Sunq6
l
5.py alt
b.SpeLiat Diuon,iuquird.
el
DName hnomt 6
o fltnin sulB
dushaulde
a oayhat
be
tshauld
w
l.h numbry
I t Shoulebu OsiHen alonq-
toiihmanulacluxu hom and, ad^uss
apiy doi h mdshlL
aluo b
shauld
menlioned on h
u lab
Sial disedilion Dedose us
6
iheshahe el
Jox uleanalue_ônly Nol hhdtt-
a
DRspenuing o unao Nmbalatosy oiuni
m
Ambulatoy,ienls ase hose sho hot ouuping
bids inhospital but ulfle
ar
h haupiial
h bulaios nlinl41 lhtmeluz 1eq1s a
he 4aifon cdunlu o hat hocbial
Ph
h oiOuslipA inslued n crs þinsing ou
nih a
he uaslalion, iht alunts a disd.d
iitulay d.balmen
hgbhysicdon iagoisihe
distasC u
l
A ion_alsihtin mdicalfon schdule-
alit odue lhe same pKsplion
el
bso
h pN Iuist
4hanuLitshoula alaz y N_aLauiion la
w
ninalt er01A
n a Dhasma eeds_any layialon_aboul
h plionhe houldenlathbe
re
bnlain#z And
n
healionSo hr
hSome on D nduc sd Dy him dlunMa
Dato
heme)qtIxy(aStS_O h
ne imrdialoly
a
m
DOEmes4.tnL_OutpalLentApuan4LEn
Cstnsin p_emes4AntyB öxaLLHeni
taxeoYcondRan whiLh Oi Ieal_AY
ar
Lase
Dse BeclNec RmLxgen
a
aoYDhine nd6lhidne
dui JaioupupasloLonhoon h
m
Y
Led diug Kycholsbi
Mantoiis and
Lugahes and suchb_
sudahs
ase
Ht,195 0asaed
sthdule X_o u
tnitd in
ar
Subs 19uo.
ghd losmeii Hd mainlained_
StaxalYeqisisYLgis lth_shouldbebxoeduie
Ho eod ihem_and a(onialled
iUed issueo Ph ec
secdtue dhes ciugs.
-Medialsaheailend.erit OVTalubonsible
nonlihy ofconlolled diy4.
-hig bhamaT Ou Cnd
ubonsihle. or psopedibensin odug
l
hebsoDE injoymalionR
lalblam
w
Hddxes
Dale
me
uon
and s h olhe dxua.
re
Co
ignalux o pKesibe x..
Douie o admi DLSSAalon
Ca
o
heMiplion giud qned
Medaa. by
ariliona (olalsoohatmithe palini
Duxchaspsug om_oulaid_phaima-
tan Nosol-diugs1om dh mma=
Date
- Chaxats 0
NChasats nuntoli_and o Kycht bshi_u
depetds uon aheliy ial
a
Muurs on duly lounphusitallnaxoliz
nuxihgSdolion ta ihe
the KLLOd
Lhta
m
Nuasashould almaya minlain a_abey
Neloxg in tace dEoasidgeLlonlamLna 1n
ar
l Ph
el
w
re
Ca
Haspitalomula Date
a
Dine HaspilaomulaiyDib ithLs &
Ane delelion rug
Hohlight ddiion
o hospilal omulay-
m
Ihe hoprtalpmulaxy, ,a lit
he olphaymoituliial
ar
aqistoiih 1t impbkiant, inDrmalion hith
he uINi_inital
mécicalStat
vieuos ohe
The hospiiaomulaiy sylen AsKlsin poLuYLng
Ph
pxesLibingdiDEnsingAnd adminNeXLnga diug_
und hAir _non-psiiary a J
opielay-
nomeSLbhent drugs have olh_ nmms
he main sponiBi y 6 ao maing muLal
iobhgimacyOndhea.þruilie(ommil.e
he tommifeeoha
l
CIlain__dxug and he
dion_about inulusion o-
bharaLit OA he
el
a
gives mediLine in.oxma tian io sident
sta buxes ang. udene
m
imbxovhe4uality0SuYgnl@ and-
aRASLe_dis pen
n
eduush inyandony Cos ahedzug
ar
tumavLs the naliond Lombinations o
Conlen o
Ph
osmulas
Ihoain dbitiue osmuloy la
subly uselul inloxmalfonda iheu_bisCribes
od o_tonsol he ue o dxuqs.
l
el
dName ocuqs
Le
Liono paiitni in tle ar emJ.
Repo
Rebal lionoie Lleainstucio-
ovoiddispensng Rio
a
prLiber
m
imaIy odituiiv a
Inoamalian odauq produit approved by
ar
Hheapeuil
PTand ovide asiL
n4oYmation
iis n_oY mulaxy
nai o nam& Ph
basiL druq
Lommo.h, names &brand hamtj
hsaaoOxmsenathachaqing
-Keule administiadfon
Cost
l
onsibifnlisi_on
Onbimotion hospual tqulolion goveininf-
a
abbxeuiaiion- and sheuia inamalion_abou
m
dxua-
ar
Hos
Oemiation_ bilal 01mulany and
Druq lüt
ox mulaiy Ph Urug lit
1 e hamotouoed qeneriL hamil olloued
onhydala
orm onsenth
binj6xmaliorn
gikoxmposalka
Hoxralo
l
2.blahed in LOnuenitniSine 0i4
el
S12e
tnd bhaxmaclsis
re
or delelon a aq-
a
drtten
m
daugpsocdluctlo bt manuaclund ba
The
nseatOmbany,1h lh a4oo.c 1coid
geIle Yom.poslion_uol_pe
ar
6bxEDaralion
Cons ide
he daugso ablsheddhr,peui liay
Con Ony addrd o heomulaiy
Ph
Subfp dhyg musf _be
he bhashacoloeia _iljona oxmulan esni i h
ht
he ubeclre di uq_bxpdu should uccie
habbxouall
hitoIicoualucDyne
local, eiolebhySicians tanonly
l
he byepaytion_ ot Ånouon tom bson
el
be add.d OimulaIY
esalbe
mullpleingdient
gdmi Hed
h Same herrpeulic
ingseciim
by ihe useDSingt
w
ahived.
DxeDAIalion
re
Ca
a
enanio În Indi* tToD
m
hSIhembruli dhuy onitoxing isuling ihat_
he dmoun o
measurL
H
Glain mtitins
in your bload ain
ar
dugs Lth _a nayothera jeuli uoicou
T done 0_mlle the amountl
SuL
mtcliine 0dYealaing boihsale.
Ph
oodeftet.
ox Om o lh useeulher mut be
eladions _blus dpse, blaumd or bloadcdug
cdug
Lonueniiation and phaymáLody namic
e
l
The Tom_Koss
el
Biologital samble-
w
lhe eaquesl
re
Laboxalo1y measuTLmenT
inital inlexbxelalion.
lhaxabuuiL manaqement.
a
2.ovdirg meciical gdvoniog Dtduting h
chaneodaug loi Nbe diseseSlalo.
m
3.onioringo olhuior
nleni' haxactyislizg,dug inttaLfons.
nliYalians.
h ord lo iduet palitnWaxiabii
ar
4.iavicding- onuenLtnLe lo hJ
elonami
aliiniby byshoxlening4- ihei ospital lau.
Ph
aclos do be considrd uiny DM
LAxdiac lailur
4 e osalsa n popaholbl
dug moniloxinq hium,
re
He diu mani1
MLdiine_ox samblinqio- 0M resuli
in ompaiible 6ih_daug cidminisitilian
Teconcheboasibilisoamedicalan
dexd Oy
Samping Y1Orshould be_oní
lein binding ordug tohiih ae_
a
Alderd
stongla bound o þlaumabsoleins
eduued albumin ltvlLmy
m
Chenyioin
highe _ton 0 unbound druyde
druea.
Kesa in
ar
Indian scemio o DM
ID0 a
Ph
inlsodued in_idlia in mid 192o,
or41040h
an years hoveSun
laL 20 ualtd
iill
no qaldioYy 4uidtlines
in indian haspidl.
dinicalhormaPacchlante O4 nliremedital
Nud Supboiand osson
,
l
haum couxseinilodued by
Lonsiuctivecollaboialion
should
he individualphaymausT ALudemi leadex
eadex
blu
blu
w
Adminislhalion 0 and
ainingand
Ond huilal
oimulaiion blus he uaulous
re
NpSliLaltansoTOMn_
a
a and
quiiemeni and
m
batients dose
lo_se.dit medkalion(ombliane_
SS dosingRqLMN
abb1obriatc.nAsKados
oasstss the minimunm ton Yecurod
ar
amainlain, he
txhibii ioy þexiod nmded_lo,
lo minimni He lime
dosage 4dumeni and a asstss he
Ph
lo dedily boisons he
severi oisonin4 n nlmkIqeny_hi
l
el
w
re
Ca
phax hcacem.tni.
a
Cammuniiypno macymanqemtnt_inpitAem_
aciues inuold in he O1gant2alan
m
all
and diuiRon,
ancd gtiling-peoble hea o
acomblih_dad qootdnd ohjli
phaimaY_enleisers
ar
inahtiol nmanagemenf
maleing
bailt
ehcitnt
athievinghis abjecive
uiL o inancial yaIoLr-
is
and
and buyinyeh oii.
Cash 4inancial sOuY 8
unpaaoinar
w
guipmtn].
pubuYhasee Als malexialpnd olhe maleial.
stach Ondsupbly
hain tain and
aSalat,lnqts
roclucs
and
xc
inctnla chaxgg
Ca
a
sbetialtoanguageAsed oy
Jndi
Ncibuntingia
a
m
Commuh taling
inancialindorhai h
Ahiouah
tommumilalécdhiough
inoxmaiionis
hanfgl stalment
ar
inloxmaiion
nanctalL dalemtni piouIde
maaS and hey belies asseSh
dsion npliaiion ap uazious deifon
inantia
MuS
_ Mah Ph
ue hiinoxmdlioh a
ihey
ion mkt
ilyard tHeLiwly angqehei
ONGahiSafianL
aal manaqemen.
l
a0oxcinaiing
el
onaollng
blanninadienqonoll ing
amalerialond he
toaxdipaifnghehiulis
ikuniony1quixe
Conurned
mens
th
w
Siochig-
E|Cading
re
peiabiingahiingNenilton Ymalure
Masehah lola he Lapilal o an
enlaprise is inkied n n jaits
une on_os1oclhi
malexials.
utulay suplyxgannalion
iablüh
ovide sevfe a the n_mos
a
RLOnomi
oiem
hobeidtniation oond ks0caion
m
utikialfoh oreaL
Eien
hyaicalSioching 0nd ithelaing maleaia.
MndYing and Spetdy MuLo
ar
Kwing slor a4ainJt dama4
Kecn_ogoodJ in
Slobing0 in_dug slone
Ph
manu.laLlu
HoXding dodo_bhahacalog1Lcal
HLoydin
adion
-Nibhobeiieal ojde
per old sdoca_and dole oupiy-
l
el
LoLalion eaedlores
Should_be af hlate
The ocalion ouiores
w
Y mony planLSualedto
hen i coble hauonesnlalis
1
Oairgal Lodltunlion
a
ihe DOLRSSo igniny (ocde
he o
m
bay
humbrr Oy CodL Jg bo
maleria _pr RaIy URAenRralfan
ar
unnlag
dthiiAian otn
Jhelbs n eapMtitalcoliniin
hlbshbsin gaoupingheSIhiak jdtm lsg
Ph L
in
htlbs
esinhsheien o h malnaay
dupliLalan o lt
Jhelb. în avdiding
l
Meihads eLodiicalior
el
AphabaLaoxdey
nenopiL memd
.
methodlHuode
w
Jiud otaon
Randoxnocalion
Zona localion
Ca
a
ensuxedhe rouide
numah,
JOLalSali talion. o he
m
Der onal and
mploy
ng
ar
Umpoxlanee
up_q healb oghi2alfon
la helbg o
bull Beroyman ad
inohi hejob Ph
mp.loye Lan
Lan be
De
Saiisadion o Ve
he ganizalon
SingpouidesH inlo iqhT peason
in &ucling heoiqanizalion
Eploeesi
l
mas aluable asset ool an 0zqaniLaiion.
el
n asuciuse tquiYmeni.
mthoad
w
onVenitnc
a
Hacor do ConiTdeY_
m
alaiion Chaxa idiisSuth as obulalion
S12 A100ih Yale
QU Oioninc hCom
ar
dislxibuYionpyuCiblion byingoLed
hasitianaaikbillasuch d humbrad upu
phySiuan
inúnting
O Suh_0s
Ph IqulYumtni a AOUiLL 6
und
2.a mists
Neat lean enuiomeni ap
nRad bu t and oiih su tnj sloxuge
aa
l
onnin4 moin jainecLodh S
Lasila iden H.ied bq ihe public
el
om oiluxeheoad1ih
Lthl unniu hed toansling aaolh able,Lho
re
- eige1ol6xSioxqge auil
quipmen eponted n schdule NA DLai
Ca
a
Haitni
m
Amedigalian biloKy ia drloiled ,aurale
anc omblal auOuni all Dauhed and
mtdicaiion.
tonxLbed comblele înloimaiion_apout Oalint
ar
xtuide piio
medicintshat ad aauh 'oy is uLIenilyahing
Nedox ox alint Ph Medizadfon Inleuius
Ihe aim_o mediLalion huloiynleuieu egaYclnq
dug use haf ay asit iouEY ala oV
ailn
A gaod medizaiion huloryshould entom_p0ss ll
l
Ladunlycind etnilyarbrcl, 1Ouudgs
el
a
PATIENT MEDICATION HISTORY INTERVIEW FORM
m
Date:
NAME:T Birthdate
Last First MI
ar
Age: Sex: OF OM
Please list the names of other practitioners you have seen for this
l
problem:
el
reason):
re
CURRENT MEDICATIONS
Ca
Name of drug Dose (include strength & number of pills per day) How long
have you been taking this?
a
m
PERSONAL HISTORY
ar
birth? (specify)
Are you currently working?: Yes Hours/week- if not, are you retired disa
No sick leave?
w
Do you receive disability or SSI? Yes U No Ifyes, for what disability & how long?
re
elgion.
Ca
ophaxmacitin
a
Medfradion odheyentt deined by the uold heo lih
Osgani2alionasthe dtgiee oohith lhe
m
beson'sbe hov.our OYponds ih_lhe a4to
elonmtdalfonsom a healih_taiebiotder.
ar
The poatirnt (bn.lomantL ailbh_he povidu?
TRLOmmLndatian_toth 1espe o ming _do.sa.ge
Lancd rqutnty O mediçalion hhing duii
Hhe hACTibed lenglh Ph oim
aatoa ihat diming he hapeulft
su engso.m
tomein illneas
in apaiiuni
hxonic diseast.
l
LO -ltonomiL
Lach o amily d sorial supoy_
Laab a nahtia
w
YRsoLILLS
usy o ichedules
-Hfok osomtdicaiion.
re
a
Lagh
advust side eis
m
Sxssanxily
m ainminiuth asuiaual,hiaiingad
anc iualloaine pxoblem
Cong hiliuE inpalr mint
ar
haimaLidaKole in med icoalon adherena.
har ma.iii tan Ph îmbiOMe medicalion odherece
baeheyan tan_aclually shatlhe _medicalion
thoiniand And yelae any in.lannmalion to_
Hh mtdicajion lf
-Edurade oin
P
hgovding _mecicalion adberenta
Aphax matii ton sduize to -þeLibus _on ik
l
simblilicaion 6 dug segimensandigntns
G acozs ohih mdy ton bui ioLoaYds
el
medicaion on adheentt
phavmouist tan_atshe mitil' hnounledat
ohedrug heapy anc ua
meditalian
w
re
Ca
a
-Beitndlu
-move_¢bmmuniLalion_shill
m
nprouingbaleni tducolion
_explanalfon
-4ive cley undsianding
balnL
h-Chech heheaide tHe_ mens
ar
bnor he huopuli eqi
Simb
Samlanguagopolien
-Shahe
Danilar the hneiia
ec
Ph
1nadminidiscaiion
Invwlu mtni iiini
l
el
w
re
Ca