Inpatient Dispensing Verification

PATIENT ORDERS

UNIVERSITY MEDICAL CENTER

Patient Information

Patient Name: Gary Hanes

Medical Record: 628564 Ward: 1-South Room Number: 113-1

Age: 66 Weight (kg): 95.7 kg Height: 5' 9"

Allergies: None Adverse Drug Reactions: None

Diagnosis: Pneumonia, pernicious anemia, hypothyroidism, depression, constipation

Final Medication Reconciliation List

Date

Time

Orders

1-6-XX

12:42

Zosyn 3.375 g q6h

Vitamin B 1000 mcg monthy, due on 1-9-XX

Synthroid 0.075 mg qd

Prozac 20 mg qd

Tylenol 325 mg i or ii q4-6h prn

MOM 30 cc qd

Orders to be entered by treating physician: S. Jones

MEDICATION ADMINISTRATION RECORD

24HR MAR - ADMINISTRATION DATE:1-7-XX
Patient Name: Gary Hanes Physician: S. Jones
Medical Record: 628564 Ward: 1-South Room Number: 113-1
Allergies: None Adverse Drug Reactions: None
Order Start Date	Order Stop Date	Order Type	Medication	Directions	Admin Times	Time / Initials	Notes
1-6-XX	1-20-XX	C	Levothyroxine 0.075 mg tab	0.075 mg PO QD	0900	0840 RC
1-6-XX	1-20-XX	C	MOM 30 mL, unit-dose cup	30 mL PO QD	0900	0846 RC
1-6-XX	1-20-XX	C	Prozac 20 mg cap	20 mg PO QD	0900	0842 RC
1-6-XX	1-20-XX	P	Acetaminophen 325 mg tab	650 mg PO Q4-6H PRN		1248 LS, dose effective
1-6-XX	1-20-XX	CIV	Piperacillin/Tazobactam 3.375 g/DW 100 mL	3.375 g IV Q6H	0500 1100 1700 2300	0542 RC 1130 RC 2300 LS

PATIENT ARM BAND

Patient Name: Gary Hanes
Room Number: 113-1
Allergies: None
ADR: None

MEDICATION DRAWERS

Fluoxetine 20 mg Capsule Lot Num: 79432 Exp Date: 4-12-XX Pkg by: Eli Lilly	Doses: 1
Levothyroxine 0.025 mg Tablet Lot Num: 36985 Exp Date: 3-8-XX Pkg by: Abbott	Doses: 1
Milk of Magnesia 30 mL Unit Dose Cup Lot Num: 55544 Exp Date: 8-3-XX Pkg by: UDL	Doses: 1
Acetaminophen 325 mg Tablet Lot Num: 87321 Exp Date: 2-20-XX Pkg by: UDL	Doses: 8
Piperacillin/Tazobactam 3.375 g/DW 100 mL IV Lot Num: 32144 Exp Date: 5-6-XX Pkg by: Wyeth	Doses: 4