Inpatient Dispensing Verification

PATIENT ORDERS

UNIVERSITY MEDICAL CENTER

Patient Information

Patient Name: Delma Lane

Medical Record: 608312 Ward: 1-North Room Number: 118-1

Age: 38 Weight (kg): 61 kg Height: 5' 7"

Allergies: NKDA Adverse Drug Reactions: None

Diagnosis: Bipolar (noncompliant), cardiac arrhythmia, sinus tachycardia, occasional HA's

Final Medication Reconciliation List

Date

Time

Orders

2-4-XX

14:25

Zoloft 100 mg qd

Multiple Vitamin 1 tab qd

Klonopin 1 mg bid

Depakote 250 mg bid

Inderal LA 120 mg qd

Motrin 400 mg q6h prn HA

Orders to be entered by treating physician: G. Platz

MEDICATION ADMINISTRATION RECORD

24HR MAR - ADMINISTRATION DATE:2-5-XX
Patient Name: Delma Lane Physician: G. Platz
Medical Record: 608312 Ward: 1-North Room Number: 118-1
Allergies: NKDA Adverse Drug Reactions: None
Order Start Date	Order Stop Date	Order Type	Medication	Directions	Admin Times	Time / Initials	Notes
2-4-XX	2-18-XX	C	Divalproex 250 mg tab	250 mg PO BID	0900 2100	0845 BC 2118 MS
2-4-XX	2-18-XX	C	Multiple Vitamin tab	1 tab PO QD	0900	0835 BC
2-4-XX	2-18-XX	C	Propranolol ER 120 mg cap	120 mg PO QD	0900	0847 BC
2-4-XX	2-18-XX	C	Sertraline 100 mg tab	100 mg PO QD	0900	0833 BC
2-4-XX	2-18-XX	P	Clonazepam 1 mg tab	1 mg PO BID PRN
2-4-XX	2-18-XX	P	Ibuprofen 400 mg tab	400 mg PO Q6H PRN HA		1750 MS, dose effective 2105 RD, some GI upset

PATIENT ARM BAND

Patient Name: Delma Lane
Room Number: 118-1
Allergies: NKDA
ADR: None

MEDICATION DRAWERS

Multiple Vitamin Tablet Lot Num: 32145 Exp Date: 1-4-XX Pkg by: UDL	Doses: 1
Propranolol ER 120 mg Capsule Lot Num: 47586 Exp Date: 6-25-XX Pkg by: ESI Lederle	Doses: 1
Sertraline 100 mg Tablet Lot Num: 76321 Exp Date: 7-30-XX Pkg by: Pfizer	Doses: 1
Valproic Acid 250 mg Capsule Lot Num: 64789 Exp Date: 2-15-XX Pkg by: Qualitest	Doses: 2
Clonazepam 1 mg Tablet Lot Num: 19787 Exp Date: 9-6-XX Pkg by: Mylan	Doses: 2
Ibuprofen 400 mg Tablet Lot Num: 57319 Exp Date: 8-4-XX Pkg by: UDL	Doses: 4