HARYANA STATE HEALTH RESOURCE CENTRE

Page No.1 Doc No. : DQAU/2018/UPHC MM/Rec/Audit(Pres)/13/1.0

Issue/ Revision No. : 01/ 00

DISTRICT QUALITY ASSURANCE UNIT, KURUKSHETRA

Name of Facility………………………..
Month………………………
Prescription Audit
Fill 1 for
Sr.
Attributes 'Yes' and
No.
0 for 'No'
1 Medication order bears the name of the doctor
2 Prescription bears the name of the patient that is legible
Prescription bears the second patient identifier as
3 Age/Address/Father's or Spouse Name Medication orders are Legible
and Clear
4 Patient registration number is mentioned
5 Medication orders are signed by authorized person
6 Medication orders are dated
7 Medical Component –Diagnosis is written
8 Medical Component –Brief history is mentioned
9 Medical Component- Salient features of clinical examn is written
10 Investigation orders are legible and Signed
11 Drugs are prescribed by their generic names
12 Medicines advised are mostly available in the facility’s dispensary
13 Dosage schedule and doses of prescribed drugs are mentioned
14 Frequency/Time of Administration clearly written
15 Duration of drugs is written
16 Route of administration of drugs is written
17 Follow-up is mentioned
18 Required precautions/ Do’s & Don’t’s recorded
19 Medication orders are signed by authorized person
20 In case of referral, relevant clinical details are mentioned