Notre Dame University

COLLEGE OF HEALTH SCIENCES

Cotabato City

DRUG STUDIES
Name of Student: ___________________________________________________________ Group : _______________________________
CI: _______________________________________________________________________ Area of Assignment: _____________________

A. Patient’s Baseline Information:

Patient’s Name: _____________________________________________________________ Date Admitted: ________________________
Age: _______________________ Weight: _____________________________
Chief Complaints: ___________________________________________________________ AP: _________________________________
Diagnosis: _________________________________________________________________

B. Medical and Health History

What prompted admission/ consultation? __________________________________________________________________________________________________
When did symptoms occur? _____________________________________________________________________________________________________________
What are other drugs you are taking for the last 2 weeks? _____________________________________________________________________________________
____________________________________________________________________________________________________________________________________
History of allergy: ____________________________________________________________________________________________________________________
 DRUG ORDER MECHANISM OF ACTION INDICATION CONTRAINDICATIONS ADVERSE EFFECTS NURSING RESPOINSIBILITY
(4) (4) (3) (1) (1) (7)
Generic Name: Pharmacokinetics & Before Administration (2):
Pharmacodynamics

Brand Name:

During Administration (3):

Pharmacologic
Classification:

Usual Dose:

Therapeutic
Classification:
After Administration (2):

Actual Dose: