Nurse Delegation: Prn Medication
ADVERTISEMENT
1
2Nurse Delegation: PRN Medication
TO BE COMPLETED ONLY IF PRN MEDICATIONS ARE DELEGATED
1. CLIENT NAME
2. DATE OF BIRTH
3. ID/SETTING (OPTIONAL)
4. DATE ORDERED
5. NAME OF MEDICATION
6. DOSE/FREQUENCY/ROUTE
7. NOT TO EXCEED
8. REASON FOR MEDICATION
9. SYMPTOMS FOR ADMINISTRATION AND AMOUNT TO BE GIVEN
10. NOTES
11. RND SIGNATURE
12. DATE
4. DATE ORDERED
5. NAME OF MEDICATION
6. DOSE/FREQUENCY/ROUTE
7. NOT TO EXCEED
8. REASON FOR MEDICATION
9. SYMPTOMS FOR ADMINISTRATION AND AMOUNT TO BE GIVEN
10. NOTES
11. RND SIGNATURE
12. DATE
4. DATE ORDERED
5. NAME OF MEDICATION
6. DOSE/FREQUENCY/ROUTE
7. NOT TO EXCEED
8. REASON FOR MEDICATION
9. SYMPTOMS FOR ADMINISTRATION AND AMOUNT TO BE GIVEN
10. NOTES
11. RND SIGNATURE
12. DATE
To register concerns or complaints about Nurse Delegation, please call 1-800-562-6078
DISTRIBUTION: Copy in client chart and in RND file
DSHS 13-678A (REV. 04/2013)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal