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NCH Paramedic Program DRUG CARD TEMPLATE
• Type in shaded area to fill in form.
• One drug per page/sheet of paper (after review, keep alpha file of card/sheets in binder).
• Drug cards may be used for multiple pts if information submitted is complete & accurate.
• May complete one (1) card for drug classes (e..g., ACEI, beta blockers, SSRI) if drug names (generic & Brand) are included.
|Name: generic | |
|Name: Brand | |
|Class | |
|Actions | |
|Indications/Uses | |
|Contraindications | |
|Precautions | |
|Dose & Route | |
|Known incompatibilities | |
|Adverse Effects | |
|(frequent/serious) | |
-----------------------
Faculty
Approved
Date &
Initials
................
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