Block 4 PO MAR practice
MCCDNP Hospital
MEDICATION ADMINISTRATION
RECORD
DIAGNOSIS: CHF, A-fib
STOP
DATE
VERIFIED
BY
RN/LPN
(INITIALS)
AGE: 86
SEX: F
HT: 4ft 11in
WT: 132lb
FOR DATES AND TIMES:
xx/xx/xx 0700 to xx/xx/xx 0659
ALLERGIES: Tagamet, Codeine
START
DATE
NAME: Lotta Fallings
ROOM: 205
PRN#:
2897 3645
MRN#:
00073421
ADM:
xx/xx/xx
DOB:
10/05/XX
DR:
Jones, R.
MEDICATION
DOSE, ROUTE, FREQUENCY
xx/xx/xx xx/xx/xx
MM
Lasi (furosemide) 60 mg PO BID
0700-1459
0900
xx/xx/xx xx/xx/xx
MM
Digo (digoxin) 250 mcg PO daily
0900
xx/xx/xx xx/xx/xx
MM
Potassm (potassium chloride)
20 mEq PO BID
0900
Cefazolin 2 g/100 mL intravenous
daily
1500-2259
1700
2300-0659
2100
0900
Ceftriazone 2 g/1 mL intravenous
daily
AS NEEDED AND ONE TIME ORDERS
Signature
Initials
Misty Marshall, MS, RN
MM
Signature
Initials
SITE LEGEND
RUC Right Upper Chest
LUC Left Upper Chest
RA Right Arm
LA Left Arm
RVG Right Ventrogluteal
LVG Left Ventrogluteal