DATE OF BIRTH: AGE: ‘CONSULTANT DRUG PRESCRIPTION | rrcan (ote number: DATE OF ADMISSION: AND ae ace ADMINISTRATION KARDEX NO.: WET oAgmy — RECORD nae nevEw ox: oe cain taeoerane. | See [ eee | eR | Goma |e eee te DRUG ALLERGIES (and menffosillon of sams) FOR THE SAFETY OF THE PATIENT GENERAL 1 Ensure tha al pation dtale are onored abow. 224 hour dock must bo used when chering nd recording modiatins ocTor 1. Has adr logy history boon taken? Signet: Use approved names, BLOCK LETTERS, mebie doses, English insbustions. Avid abbrevstons, ‘Any changes in drug thorapy must bo ordorad by a naw mrsctinon Diocontinue a deg by drawing ine though lt anda snr ine tough subeoquont cording panel ad sign ‘Only one chia shou be in use at anyone ine When the chat full current prescipsons shoul be eneres ‘ons new chart and tw old one ted inthe pit’ note, 16. Ente nstuctons fr holiing drags on Page 2 seep nurses 1. Check the ent In evry section to ald omissions. 2 Admisistoring Registered Nurse intial apropite box. 3. Inthe event of ro-ainitaton of crag ete = 84 ertorXin tho appropriat bx and err deta on page 12.08, = 82 the patient has retused a dug, ent Rin the appropriate box OB, ~ 38th ptiont nas boon fasting, enter F inthe propriate box. 4. Check hat he drug has nat lady been admired 5. When dose changes ae prescibed poase spect dose actualy administered along wih nas.HOLD DRUGS SURGERY UNLESS SPECIFICALLY STATED OTHERWISE, TOGETHER WITH PRE-MED ONE om ‘wu P00 EAS boston ONCE ONLY DRUG & FIRST DOSE MEDICATION noc esAS REQUIRED [booms [Rss Bia ne 7 apse ——— a fom laa eRe rer oar