CARTA PENGUBATAN (ANTIBIOTIK) farhsdg/IP-32

HOSPITAL SERDANG
Nama Pesakit:
No K/P: Berat: KG
SD NO: Umur: ALERGI & KESAN ADVERS UBAT (wajib diisi):
Wad: No. Katil:
Jantina: Lelaki / Perempuan

PRESKRIPSI UBAT REKOD ADMINISTRASI UBAT

Nama Ubat & Administrasi: TARIKH
Hari
1 2 3 4

Masa A B A B A B A B

* on eHIS:
Dose: Frekuensi: Durasi:

INDICATION (Sila tanda √) REASONS TO CONTINUE BEYOND 72 HOURS

Empirical 1.Positive preliminary result
Diagnosis:……………………………….. 2.C+S results: Sensitive to current antimicrobial
Treatment 3.C+S results: Sensitive to other agents but unable to de-escalate
Isolated Pathogen:……………………… 4.C+S no growth but unable to de-escalate
Mula oleh: SPECIALIST/CONSULTANT Tamat oleh:
T/tangan & Cop Doktor: T/tangan & Cop Doktor:
Tarikh: Tarikh:

PRESKRIPSI UBAT REKOD ADMINISTRASI UBAT

Nama Ubat & Administrasi: TARIKH
Hari
1 2 3 4

Masa A B A B A B A B

* on eHIS:
Dose: Frekuensi: Durasi:

INDICATION (Sila tanda √) REASONS TO CONTINUE BEYOND 72 HOURS

Empirical 1.Positive preliminary result
Diagnosis:……………………………….. 2.C+S results: Sensitive to current antimicrobial
Treatment 3.C+S results: Sensitive to other agents but unable to de-escalate
Isolated Pathogen:……………………… 4.C+S no growth but unable to de-escalate
Mula oleh: SPECIALIST/CONSULTANT Tamat oleh:
T/tangan & Cop Doktor: T/tangan & Cop Doktor:
Tarikh: Tarikh:

PRESKRIPSI UBAT REKOD ADMINISTRASI UBAT

Nama Ubat & Administrasi: TARIKH
Hari
1 2 3 4

Masa A B A B A B A B

* on eHIS:
Dose: Frekuensi: Durasi:

INDICATION (Sila tanda √) REASONS TO CONTINUE BEYOND 72 HOURS

Empirical 1.Positive preliminary result
Diagnosis:……………………………….. 2.C+S results: Sensitive to current antimicrobial
Treatment 3.C+S results: Sensitive to other agents but unable to de-escalate
Isolated Pathogen:……………………… 4.C+S no growth but unable to de-escalate
Mula oleh: SPECIALIST/CONSULTANT Tamat oleh:
T/tangan & Cop Doktor: T/tangan & Cop Doktor:
Tarikh: Tarikh:
* Sila tanda √ jika telah pesan melalui eHIS
A - Tandatangan pemberi ubat B - Tandatangan saksi pemberi ubat