ST. MARY’S COLLEGE OF TAGUM, INC.

HIGHER EDUCATION DEPARTMENT – NURSING PROGRAM

National Highway, Tagum City, 8100 Davao del Norte, Philippines
Quality Transformative Ignacian Marian Education

Name of Patient: ________________________ B-Date: ___________ Age: _____________ Sex: ______ Ward/Wing: _______________ Room/Bed #: _____

Generic Name Classification Side Effects Contraindication

Maternal:

Neonate:

Brand Name Onset of Action Adverse Effects Nursing Intervention

Maternal:

Neonate:

Route, Dosage, and Frequency