MEDICATION ADMINISTRATION RECORD (MAR)
Name: Christian Santos Nadela Age: 87 Attending Physician: Dr. Yu
Sex: Male Civil Status: Married Room No. /Bed No. Hospital No.
MEDICATION: Date: 8/21/20 Date: 8/22/20 Date: 8/23/20 Date: 8/24/20
Dosage, Route, Time NOD NOD Time NOD NOD Time NOD NOD Time NOD NOD
Frequency 1 2 1 2 1 2 1 2
Cefuroxime 1.5 gm IV 10:52 SIGNED 8:00 SIGNED 12:00 SIGNED 12:00 SIGNED
drip q8H ANST 4:00 SIGNED 8:00 SIGNED 8:00 SIGNED
4:00 SIGNED 4:00 SIGNED
Citicoline 1 gm IVTT 10:52 SIGNED 6:00 SIGNED 6:00 SIGNED 6:00 SIGNED
q6H 12:00 SIGNED 12:00 SIGNED 12:00 SIGNED
6:00 SIGNED 6:00 SIGNED 6:00 SIGNED
12:00 SIGNED 12:00 SIGNED 12:00 SIGNED
Ampicillin + 4:00 SIGNED 6:00 SIGNED 6:00 SIGNED 6:00 SIGNED
Sulbactam 1.5 gm IV 8:00 SIGNED 12:00 SIGNED 12:00 SIGNED 12:00 SIGNED
drip q6H 6:00 SIGNED 6:00 SIGNED 6:00 SIGNED
12:00 SIGNED 12:00 SIGNED 12:00 SIGNED
Diphenhydramine 50 8 SIGNED
mg/amp 1 amp IVTT
Alprazolam 500 1:27 SIGNED
mg/tab ½ tab
Signature Specimens:
(Provide signature beside full name in print)
DOH-SWUMed-NSD-F-013 Rev.2
MEDICATION ADMINISTRATION RECORD (MAR)
Name: Christian Santos Nadela Age: 87 Attending Physician: Dr. Yu
Sex: Male Civil Status: Married Room No. /Bed No. Hospital No.
MEDICATION: Date: 8/21/20 Date: 8/22/20 Date: 8/23/2 Date: 8/24/20
0
Dosage, Route,
Time NOD NOD Time NOD NOD Time NO NOD Time NOD 1 NOD
Frequency
1 2 1 2 D 2 2
1
Memantine (Memry) 8 SIGNED
10 mg/tab, ½ tab OD
Clopidogrel (Plogrel) 8 SIGNED
75 mg/tab, 1 tab OD
Citirizine 10 mg/tab, 8 SIGNED 8 SIGNED 8 SIGNED 8 SIGNED
1 tab OD, PO qHS
Atorvastatin 40 10:52 SIGNED 8 SIGNED 8 SIGNED 8 SIGNED
mg/tab, 1 tab OD, PO
Pantoprazole 40 10:52 SIGNED 6 SIGNED 6 SIGNED 6 SIGNED
mg/cap OD PO ac
breakfast
Anthromycin 500 10:52 SIGNED 8 SIGNED 8 SIGNED 8 SIGNED
mg/tab, 1 tab OD, PO
x6 days
PREMACIO JUVIELY C.
SWU PHINMA – CN
STUDENT NURSE
MEDICATION ADMINISTRATION RECORD (MAR)
Name: Christian Santos Nadela Age: 87 Attending Physician: Dr. Yu
Sex: Male Civil Status: Married Room No. /Bed No. Hospital No.
MEDICATION: Date: 8/21/20 Date: 8/22/20 Date: 8/23/20 Date: 8/24/20
Dosage, Route, Time NOD NOD Time NOD NOD Time NOD NOD Time NOD NOD
Frequency 1 2 1 2 1 2 1 2
Sultamicillin 8 SIGNED
750mg/tab, 1 tab BID 6 SIGNED
x7 days
Citicoline 1 gm/tab, 1 8 SIGNED
tab BID, PO 6 SIGNED
Atorvastatin 8 SIGNED
40mg/tab, 1 tab, OD
HS
Losartan 50 mg/ tab, 8 SIGNED
1 tab OD, PO
Amlodipine 5mg/tab 8 SIGNED
1 tab OD
