Inpatient Dispensing Verification

PATIENT ORDERS

UNIVERSITY MEDICAL CENTER

Patient Information

Patient Name: Brian Green

Medical Record: 472065 Ward: 3-North Room Number: 311-1

Age: 71 Weight (kg): 80 kg Height: 5' 11"

Allergies: Nicotine Patches (rash) Adverse Drug Reactions: None

Diagnosis: COPD, BPH, HTN, Bronchitis

Final Medication Reconciliation List

Date

Time

Orders

11-6-XX

11:40

Flomax .4 mg qd

Duoneb q6h while awake

Norvasc 5 mg qd

Rocephin 1 g qd

Tylenol 650 mg q6h prn pain

DW 1/2 NS @ 70 mL/hr

Orders to be entered by treating physician: G. Platz

MEDICATION ADMINISTRATION RECORD

24HR MAR - ADMINISTRATION DATE:11-8-XX
Patient Name: Brian Green Physician: G. Platz
Medical Record: 472065 Ward: 3-North Room Number: 311-1
Allergies: Nicotine Patches (rash) Adverse Drug Reactions: None
Order Start Date	Order Stop Date	Order Type	Medication	Directions	Admin Times	Time / Initials	Notes
11-6-XX	11-20-XX	C	Albuterol/Ipratropium 3 mg/0.5 mg/3 mL	3 mL via maximist q6h WA	0600 1200 1800 2400	0615 RS 1140 TC 1806 TC 2303 pt asleep
11-6-XX	11-20-XX	C	Amlodipine 5 mg tab	5 mg PO QD	0900	0845 RS
11-6-XX	11-20-XX	C	Terazosin 2mg cap	4 mg PO QD	0900	0840 RS
11-6-XX	11-20-XX	P	Acetaminophen 325 mg tab	650 mg PO Q6H PRN PAIN
11-6-XX	11-20-XX	CIV	Ceftriaxone 1 g/DW 50 mL	1 g IV QD	0900	0645 RS
11-6-XX	11-20-XX	CIV	DW 1/2 NS 1000 mL	Infuse @ 70 mL/hr	ATC	0945 RS, new bag started

PATIENT ARM BAND

Patient Name: Brian Green
Room Number: 311-1
Allergies: Nicotine Patches (rash)
ADR: None

MEDICATION DRAWERS

Albuterol/Ipratropium 3 mg/0.5 mg/3 mL 3 mL Vial Lot Num: 12789 Exp Date: 6-6-XX Pkg by: Dey	Doses: 4
Amlodipine 5 mg Tablet Lot Num: 46332 Exp Date: 9-19-XX Pkg by: Pfizer	Doses: 1
Terazosin 2 mg Capsule Lot Num: 62102 Exp Date: 4-18-XX Pkg by: Teva	Doses: 2
Acetaminophen 325 mg Tablet Lot Num: 47963 Exp Date: 12-3-XX Pkg by: UDL	Doses: 8
Cefazolin 1 g/DW 50 mL IV Lot Num: 98777 Exp Date: 8-12-XX Pkg by: Baxter	Doses: 1
DW 1/2 NS 1000 mL IV Lot Num: 47833 Exp Date: 8-30-XX Pkg by: Baxter	Doses: 2