Inpatient Dispensing Verification

PATIENT ORDERS

UNIVERSITY MEDICAL CENTER

Patient Information

Patient Name: Lee Reeves

Medical Record: 472189 Ward: 3-South Room Number: 315-2

Age: 23 Weight (kg): 87 kg Height: 6' 0"

Allergies: None Adverse Drug Reactions: None

Diagnosis: Osteomyelitis of left radius

Final Medication Reconciliation List

Date

Time

Orders

1-23-XX

14:30

Unasyn 1.5 g q6h

MSO 5 mg q4h prn

Colace 100 mg qd prn

Phenergan 25 mg q6h prn nausea or vomiting

Tylenol ES q6h prn

Orders to be entered by treating physician: C. McDonald

MEDICATION ADMINISTRATION RECORD

24HR MAR - ADMINISTRATION DATE:1-24-XX
Patient Name: Lee Reeves Physician: C. McDonald
Medical Record: 472189 Ward: 3-South Room Number: 315-2
Allergies: None Adverse Drug Reactions: None
Order Start Date	Order Stop Date	Order Type	Medication	Directions	Admin Times	Time / Initials	Notes
1-23-XX	2-6-XX	P	Acetaminophen 500 mg tab	500 mg PO Q6H PRN
1-23-XX	2-6-XX	P	Docusate/Casanthranol 100 mg/30 mg cap	1 cap PO QD PRN		0732 SR, dose effective
1-23-XX	2-6-XX	CIV	Ampicillin/Sulbactam 1.5 g/DW 50 mL	1.5 g IV Q6H	0500 1100 1700 2300	0505 SR 1046 SR 1720 LM 2310 LM
1-23-XX	2-6-XX	PIV	Morphine Sulfate 5 mg/mL, 1 mL vial	5 mg IV Q4H PRN		0915 SR, dose effective 1730 LM, dose effective
1-23-XX	2-6-XX	PIV	Promethazine 25 mg/mL, 1 mL ampule	25 mg IV Q6H PRN N/V		1600 LM, dose effective

PATIENT ARM BAND

Patient Name: Richard Lee
Room Number: 302-2
Allergies: None
ADR: None

MEDICATION DRAWERS

Acetaminophen 500 mg Tablet Lot Num: 14774 Exp Date: 9-8-XX Pkg by: McNeil	Doses: 4
Docusate/Casanthranol 100 mg/30 mg Capsule Lot Num: 87312 Exp Date: 2-22-XX Pkg by: UDL	Doses: 1
Ampicillin/Sulbactam 1.5 g/DW 50 mL IV Lot Num: 54641 Exp Date: 1-30-XX Pkg by: Roerig	Doses: 4
Morphine Sulfate 5 mg/mL 1 mL Vial Lot Num: 47989 Exp Date: 12-30-XX Pkg by: Baxter	Doses: 6
Promethazine 25 mg Suppository Lot Num: 45700 Exp Date: 11-20-XX Pkg by: Ivax	Doses: 4