Department of Health | State of Louisiana
Section A: List of MedicationsMedication and DosageWhat is it for?FrequencyHow is it taken?Prescribing PhysicianTo be given by: self, family, staff, CMA, CNA, etc.Is RN Delegation needed? Check appropriate box.YesNoSection B. List of TreatmentsTreatment and DosageWhat is it for?FrequencyHow is it taken?Prescribing PhysicianTo be given by: self, family, staff, CMA, CNA, etc.Is RN Delegation needed? Check appropriate boxYesNo ................
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