Republic of the PhilippinesUNIVERSITY OF EASTERN PHILIPPINES

University town, Catarman, N. Samar

COLLEGE OF NURSING

DRUG ANALYSIS

Name of Patient: Date Admitted: Chief Complaint: Case Number: Age: Gender: Civil Status: Address: Ward: AP:

NAME OF DRUGSPECIFIC

ACTION(S)INDICATION(S)

CONTRA-INDICATION(S)

DRUG INTERACTION(S)

ADVERSE REACTION(S)

SPECIFIC PRECAUTION(S)

NURSING RESPONSIBILITIES

Generic Name:

Brand Name:

Dosage:

Route:

Frequency:

Classification:

STUDENT NURSE: CLINICAL INSTRUCTOR: