UNIVERSITY OF CEBU - BANILAD

College of Nursing

DRUG STUDY
Patient: Age: Hospital No.: Room No.:
Impression/Diagnosis: Attending Physicians:
Allergy to:

Generic / Brand Name Dose, Strength & Indications/Mechanisms of Adverse/Side Effects

Nursing Responsibilities Rationale Client Teaching
& Classification Formulation Drug Action Drug Interaction

Generic: Ordered: Indications:

Brand: Timing:

Classification: Duration: Mechanism of Action:

Other forms:

Printed Name and Signature: Printed Name and Signature:

Clinical Instructor: Student/s:

Note: Please provide additional sheet/s if necessary.