St.

Johns University College of Pharmacy and Allied Health Professions

PHR 4201, 4202, 5201
Prescription Counseling Worksheet

I. Name and strength of medication:

*What were you told the medication was for?

II. Purpose of medication (USE):

*How were you told to use it?

III. Directions for use: (dose, route, duration)

IV. Special Instructions for Patient: (device usage, with/without food.etc.)

V. Medication storage:

VI. Refill information:

VII. Specific missed dose instructions:

*What were you told to expect from this medication?

VIII. Efficacy/Monitoring parameters:

IX. Adverse/ side effects (common and severe - what to expect and what to do if they occur):