Professional Documents
Culture Documents
Weight (kg)
Consultant:
Diet:
12345
Surname: Patient
First Name: A
Hospital No:
NKDA
Height (m)
65
Tick if
active
oncology chart
A.Smith
Address:
D.O.B.:
Gender: Female
OR USE PATIENT LABEL
INSTRUCTIONS
Drug
Qty
Suitable
for use?
Y/ N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
To Nurses: -
Patient?
Pharmacy?
Time
prescribed
DRUG
(approved name)
Route
Dose
Doctors
signature
Given
by
Time
given
Pharmacy
Drugs Omitted: Nurses, please enter these codes on the chart. The doctor should be informed of the omission as
appropriate
1 Patient vomiting
2 Not on ward
3 Not able to take by mouth 4 - Refused
5 Drug unavailable
6 Instructions
7 Omitted medical
8 Other reason, specify in
unclear or illegible
instruction
nursing notes
REGULAR PRESCRIPTIONS
Patient Name
A Patient
2010
Month
Year
Hospital Number
October.
Date
Drug Name:
(Generic)
Dose
20mg
0600
0800
Citalopram tab
Route
oral
Additional instructions:
Freq.
Start
Stop
om 24/10/10
sos see drops protocol
Sign Doctor
Date
A.Doctor
24/10/10 A Pharmacist
Pharmacist
Drug Name:
(Generic)
Dose
Route
Freq.
Start
Stop
Additional instructions:
Sign Doctor
Date
Pharmacist
Drug Name:
(Generic)
Dose
Route
Freq.
Start
Stop
Additional instructions:
Sign Doctor
Date
Pharmacist
Drug Name:
(Generic)
Dose
Route
Freq.
Start
Stop
Additional instructions:
Sign Doctor
Date
Pharmacist
Drug Name:
(Generic)
Dose
Route
Freq.
Start
Additional instructions:
Sign Doctor
Date
Pharmacist
Stop
12345
25/
10
26
/20
27
/10
28/
10
29/
10
AN
AN
BN
CN
30/
10
31/
10
1300
1800
2200
0000
0600
0800
1300
1800
2200
0000
0600
0800
1300
1800
2200
0000
0600
0800
1300
1800
2200
0000
0600
0800
1300
1800
2200
0000
Drugs Omitted: Nurses, please enter these codes on the chart. The doctor should be informed of the omission as
appropriate
1 Patient vomiting
2 Not on ward
3 Not able to take by mouth 4 - Refused
5 Drug unavailable
6 Instructions
7 Omitted medical
8 Other reason, specify in
unclear or illegible
instruction
nursing notes
A Patient
Year
Drug Name:
Dose
1gram
Indication:
Route
oral
Pain
Start
Stop
24/10/10
Max Freq. qds
Sign Doctor
Date
Pharmacist
A.Doctor
24/10/10
APharmacist
Drug Name:
(Generic)
Dose
Indication:
Sign Doctor
Indication:
Sign Doctor
Route
Date
Start
Stop
Max Freq.
Pharmacist
Indication:
Sign Doctor
Route
Date
Start
Stop
Max Freq.
Pharmacist
Indication:
Sign Doctor
Route
Date
Start
Stop
Max Freq.
Pharmacist
Indication:
Sign Doctor
Time
Route
Dose
Given
by
Time
Route
Dose
Given
by
Time
Route
Dose
Given
by
Time
Route
Dose
Given
by
Date
Route
Date
Start
Stop
Max Freq.
Pharmacist
Drug Name:
(Generic)
Dose
12345
Date
Drug Name:
(Generic)
Dose
Hosp.No.
Date
Drug Name:
(Generic)
Dose
October
Date
Drug Name:
(Generic)
Dose
Month
Date
Paraceetamol
(Generic)
2010
Time
Route
Dose
Given
by
Date
Route
Date
Start
Stop
Max Freq.
Pharmacist
Time
Route
Dose
Given
by
Drugs Omitted: Nurses, please enter these codes on the chart. The doctor should be informed of the omission
as appropriate
1 Patient vomiting
2 Not on ward
3 Not able to take by mouth 4 - Refused
5 Drug unavailable
6 Instructions
7 Omitted medical
8 Other reason, specify in
unclear or illegible
instruction
nursing notes
A Patient
Year
Drug Name:
(Generic)
Citalopram drops
2010
Month
October
Hosp.No.
12345
Date
Time
Observation
Dose
29/10
8.30
Accepted
in orange
juice
10
AP
drops
Signature
Given by
AN
Date
Time
Dose
Given by
Route:
Oral
Pharmacy
24/10/10 at 8.00
Sign Doctor
A Doctor
CANCEL
(date and sign)
Drug Name:
(Generic)
Observation
Signature
Route
Pharmacy
Sign Doctor
CANCEL
(date and sign)
Drugs Omitted: Nurses, please enter these codes on the chart. The doctor should be informed of the omission
as appropriate
1 Patient vomiting
2 Not on ward
3 Not able to take by mouth 4 - Refused
5 Drug unavailable
6 Instructions
7 Omitted medical
8 Other reason, specify in
unclear or illegible
instruction
nursing notes