UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE

COLLEGE OF NURSING

DRUG STUDY

Patient: Age: Hospital No. Room No:

Impression/Diagnosis: Attending Physician(s):
Allergy to:
Generic/ Brand Dose, Strength and Indication/ Mechanism of Adverse/ Side effects of Nursing Rationale Client Teaching
Named Formulation (10%) Drug Action (15%) Drug Interaction (15%) Responsibilities (10%) (20%)
& Classification (10%) (20%)
Generic: Ordered: Indication:

Brand:
Timing:
Mechanism of Action:

Classification:
Duration:

Other forms:

Printed Name and Signature Printed Name and Signature

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