Drug Study Form.docx

SAINT GABRIEL COLLEGE COLLEGE OF NURSING

DRUG STUDY Name of Patient: _________________________________ Age: _____________________ Ward/Bed Number: ________ Name of Drug

Dosage, Route, Frequency, Timing

Generic:

Dosage:

Brand:

Route:

Classification

Frequency:

Mechanism of Action

Indication

Adverse Reactions

Contraindications

Side Effects

Functional:

Chemical:

Attending Physician: ________________ Impression/Diagnosis: ________________________

Timing:

Student’s Name: ______________________________________ Clinical Instructor: _____________________________________

Special Precautions

Nursing Responsibilities