PATIENT CHART
Chart for Millie Larsen Simulation #3
STUDENT NAME:_______________________________
PATIENT INITALS: ___M.L._______________________
CLINICAL DATE(S): _____________________________
INSTRUCTOR: _______________
Chart Materials Millie Larsen Simulation 3
© National League for Nursing, 2015
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Patient Name: Millie Larsen
Room: 816
DOB: 01/23/1926
Age: 84
MRN: 000-555-000
Doctor Name: Dr. Eric Lund
Date Admitted:
Physician’s Orders
Allergies: NKA
Date/Time:
Discharge home, follow-up appointment in two weeks.
Home health to follow
Regular, low-fat diet
captopril 25 mg po three times a day
metoprolol 100 mg every day
furosemide 40 mg po twice per day
Lipitor 50 mg once daily
pilocarpine eye drops two drops each eye four times a day
Fosamax 10 mg every day
Celebrex 200 mg po once a day
tramodol 50 mg. po every 4-6 hours for arthritis pain prn
Dr. Eric Lund
Chart Materials Millie Larsen Simulation 3
© National League for Nursing, 2015
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