Name of Patient: _____________________________ Date of Admission: ______________ Room: _________

Age: ________ Sex: ________ Civil Status: _________ Attending Physician: ____________________________

DRUG NAME CLASSIFICATION / INDICATION CONTRAINDICATIONS ADVERSE EFFECTS NURSING

MECHANISM OF RESPONSIBILITY
ACTION

BRAND NAME: CLASSIFICATION:

GENERIC
NAME: MECHANISM OF
ACTION:

DOSAGE:

SIDE EFFECTS:

ROUTE:

FREQUENCY: REFERENCES:
Wolters Kluwer.
(2022) Nursing 2022
Drug Hand Book.
International Edition