DRUG STUDY
NAME OF PATIENT __________________________________________
Age __________ Sex ___________ Civil Status ______________________
Nationality_________________________
Occupation _________________________
Date of Admission _____________________________Chief Complaint / Diagnosis _____________________________________________________________________________________
Brief History
Generic & Brand
Name
Frequency & Route
Classification
Action / Uses
Contraindications &
Precautions
Side Effects
Nursing
Consideration /
Patient Teaching
Name of Student ____________________________________________
Rating _________________________________
Year / Section _________________________
________________________________________
Clinical Instructor
667 F.T. Dalupan Sr. St., Sampaloc, Manila Philippines
www.marychilescollge.edu.ph / marychilescollege@gmail.com
Tel. 711 - 4233, 735-5341 to 45
Print Name & Signature
667 F.T. Dalupan Sr. St., Sampaloc, Manila Philippines
www.marychilescollge.edu.ph / marychilescollege@gmail.com
Tel. 711 - 4233, 735-5341 to 45