Manuel J. Santos Hospital Manuel J. Santos Hospital Manuel J.

Santos Hospital
554 Montilla Blvd, Butuan City 554 Montilla Blvd, Butuan City 554 Montilla Blvd, Butuan City

BID TID Q12H

Name:__________________________________________________ Name:__________________________________________________ Name:__________________________________________________

Room & Bed No.:_________________Date of Birth:______________ Room & Bed No.:_________________Date of Birth:______________ Room & Bed No.:_________________Date of Birth:______________

________________________________________________________ ________________________________________________________ ________________________________________________________

Drug & Route ADM. Drug & Route ADM. Drug & Route ADM.
________________________________________________________ ________________________________________________________ ________________________________________________________
FREQUENCY FREQUENCY FREQUENCY
__________________ ____________________ __________________ ____________________ __________________ ____________________
DATE ORDERED SIGNATURE DATE ORDERED SIGNATURE DATE ORDERED SIGNATURE

Manuel J. Santos Hospital Manuel J. Santos Hospital Manuel J. Santos Hospital

554 Montilla Blvd, Butuan City 554 Montilla Blvd, Butuan City 554 Montilla Blvd, Butuan City

OD Q6H PRN

Name:__________________________________________________ Name:__________________________________________________ Name:__________________________________________________

Room & Bed No.:_________________Date of Birth:______________ Room & Bed No.:_________________Date of Birth:______________ Room & Bed No.:_________________Date of Birth:______________

________________________________________________________ ________________________________________________________ ________________________________________________________

Drug & Route ADM. Drug & Route ADM. Drug & Route ADM.
________________________________________________________ ________________________________________________________ ________________________________________________________
FREQUENCY FREQUENCY FREQUENCY
__________________ ____________________ __________________ ____________________ __________________ ____________________
DATE ORDERED SIGNATURE DATE ORDERED SIGNATURE DATE ORDERED SIGNATURE

Manuel J. Santos Hospital Manuel J. Santos Hospital Manuel J. Santos Hospital

554 Montilla Blvd, Butuan City 554 Montilla Blvd, Butuan City 554 Montilla Blvd, Butuan City

QID Q8H HS

Name:__________________________________________________ Name:__________________________________________________ Name:__________________________________________________

Room & Bed No.:_________________Date of Birth:______________ Room & Bed No.:_________________Date of Birth:______________ Room & Bed No.:_________________Date of Birth:______________

________________________________________________________ ________________________________________________________ ________________________________________________________

Drug & Route ADM. Drug & Route ADM. Drug & Route ADM.
________________________________________________________ ________________________________________________________ ________________________________________________________
FREQUENCY FREQUENCY FREQUENCY
__________________ ____________________ __________________ ____________________ __________________ ____________________
DATE ORDERED SIGNATURE DATE ORDERED SIGNATURE DATE ORDERED SIGNATURE