Inpatient Dispensing Verification

PATIENT ORDERS

UNIVERSITY MEDICAL CENTER

Patient Information

Patient Name: Bob Smith

Medical Record: 565375 Ward: 2-North Room Number: 237-2

Age: 52 Weight (kg): 68 kg Height: 5' 10"

Allergies: None Adverse Drug Reactions: None

Diagnosis: acute pancreatitis, ETOH withdrawal, acute alcoholic hepatitis, gout, HTN

Final Medication Reconciliation List

Date

Time

Orders

1-12-XX

06:30

Zestril 10 mg qd

Zyloprim 300 mg qd

Phenergan 25 mg q4h prn

Valium 10 mg q6h

DW 1/2 NS @ 150 mL/hr

Thiamine 100 mg fluids qd

Folic acid 1 mg fluids qd

MVI 10 mL fluids qd

DC IV fluids/thiamine/folic acid/MVI on 1-14-XX

Orders to be entered by treating physician: J. Warren

MEDICATION ADMINISTRATION RECORD

24HR MAR - ADMINISTRATION DATE:1-15-XX
Patient Name: Bob Smith Physician: J. Warren
Medical Record: 565375 Ward: 2-North Room Number: 237-2
Allergies: None Adverse Drug Reactions: None
Order Start Date	Order Stop Date	Order Type	Medication	Directions	Admin Times	Time / Initials	Notes
1-12-XX	1-26-XX	C	Allopurinol 300 mg tab	300 mg PO QD	0900	0848 LV
1-12-XX	1-26-XX	C	Diazepam 5 mg/mL, 10 mL vial	10 mg IV Q6H	0500 1100 1700 2300	0513 LV 1115 LV 1730 SC 2255 SC
1-12-XX	1-26-XX	C	Lisinopril 10 mg tab	10 mg PO QD	0900	0847 LV
1-12-XX	1-26-XX	P	Promethazine 25 mg/mL, 1 mL vial	25 mg IV Q4H PRN
1-12-XX	1-26-XX	CIV	DW 1/2 NS 1000 mL Thiamine 100 mg Folic acid 1 mg MVI 10 mL	Infuse @ 150 mL/hr QD	0600	0605 LV, bag with vitamins started
1-12-XX	1-26-XX	CIV	DW 1/2 NS 1000 mL	Infuse @ 150 mL/hr	ATC	1930 SC, new bag started

PATIENT ARM BAND

Patient Name: Henry Smith
Room Number: 237-1
Allergies: None
ADR: None

MEDICATION DRAWERS

Allopurinol 300 mg Tablet Lot Num: 63478 Exp Date: 3-9-XX Pkg by: Par	Doses: 1
Diazepam 5 mg/mL 10 mL Vial Lot Num: 46321 Exp Date: 2-2-XX Pkg by: Hospira	Doses: 1
Lisinopril 10 mg Tablet Lot Num: 74322 Exp Date: 4-15-XX Pkg by: UDL	Doses: 1
Prochlorperazine 5 mg/mL 10 mL Vial Lot Num: 12366 Exp Date: 1-7-XX Pkg by: Sicor	Doses: 2
DW 1/2 NS 1000 mL IV Lot Num: 98777 Exp Date: 4-7-XX Pkg by: Baxter	Doses: 1
DW 1/2 NS 1000 mL Thiamine 100 mg, FA 1 mg, MVI 10 mL IV Lot Num: 64987 Exp Date: 9-12-XX Pkg by: Baxter	Doses: 1