UNIVERSITY OF CEBU – BANILAD

COLLEGE OF NURSING

DRUG STUDY

Patient: Age: Hospital No. Room No.

Impression/Diagnosis: Attending Physician(s):
Allergy to:

Indication / Nursing Responsibilities

Generic / Brand Name & Dosage, Timing & Duration Side Effects / Adverse Reaction /
Pharmacodynamics of Drug (Nursing Process Approach) Patient Teaching (20%)
Classification (5%) (5%) Contraindication (10%)
(20%) (40%)

Generic Name: Drug form & Dosage Indications:

Ordered:

Timing:
Brand Name:

Duration: Pharmacodynamics:

Classification Name: Other drugs forms:

Printed Name and Signature Printed Name and Signature

Clinical Instructor Student

Note: Please provide additional sheet/s if necessary