Skip to main content

proforma for data collection clinical pharmacy patients medication profile project

Patient/Case ID.NO: _______________

 

PROFOMA FOR DATA COLLECTION CLINICAL PHARMACY PATIENTS MEDICATION PROFILE PROJECT:

 

Demographic data

Patient Name

 

Age

 

Date of admission

 

Sex

M

F

Contact No

 

Marital status

Married

 

Unmarried

 

Weight

 

Address

 

Family History

 

Patient Address

 

Ward ID

 

Bed No

 

Compliance

 

Socioeconomic status

 

Allergies

 

 

Chief complaints

·         -

·         -

·         -

·         -

·         -

Present History

·         -

·         -

·         -

·         -

·         -

Previous History

·         -

·         -

·         -

·         -

·         -

·         -

Investigation

Date

Test

Results

Normal Values

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis

·         -

·         -

·         -

·         -

·         -

·         -

·         -

·         -

·         -

Previous Medicine History

Medicine with Trade Name

Generic Name

Signa

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatment At ward level

Date

Medicine with Trade Name

Generic Name

Signa

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatment at Home level

Medicine with Trade Name

Generic Name

Signa

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Side Effects

 

 

 

 

 

 

 

 

 

Interaction with drugs/food

 

 

 

 

 

 

 

Compliance

 

 

 

 

 

 

Data Analysis

·         -

·         -

·         -

·         -

Comments and recommendations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Subject in charge                                                                             ward in charge/ Hospital Pharmacist


Comments

Post a Comment

Popular posts from this blog

lung cancer

Definition: The World Health Organization (WHO) defines lung cancer as tumors arising from the respiratory epithelium (bronchi, bronchioles, and alveoli). OR Lung cancer is a type of cancer caused by uncontrolled cell division of the respiratory epithelium (bronchi, bronchioles, and alveoli). Normal structure and function of the lungs: Lungs are 2 sponge, pyramid-like organs located in the chest. Each lung is divided into sections called lobes. The right lung has three lobes while the left lung has two lobes. The left lung is smaller than the right one because the heart on the left side takes up more room of the chest. When you inhale air through mouth and nose it enters into lungs through trachea (windpipe). The trachea divides into tubes called bronchi, which enter the lungs and divide into smaller branches called bronchioles. At the end of bronchioles there are small tiny sacs called alveoli. These alveoli absorb oxygen from the inhaled air into your b...
13 comments
Read more

what is asthma? epidemiology signs symptoms prevention and treatment of asthma.

ASTHMA:  The word "asthma" is   from the Greek ásthma, which means "panting". DEFINITION : A common lung disorder in which inflammation causes the bronchi to swell and narrow the airways, creating breathing difficulties that may range from mild to life-threatening.            “ OR “ Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person.(WHO). Normal airway, Asthmatic airways, Asthmatic airway during attack              ·         Asthma was recognized as early in ancient egypt. ·          It  is a common long term inflamatory disease of the airways of the lungs. ·         It is characterized by variable and recurring symptoms, reversible air flow obstr...
15 comments
Read more

Corona Virus COVID-19 SARS-CoV SARS-CoV2 Novel corona virus COVID Corona

COVID-19; Stand for  coronavirus disease in 2019 . The name COVID-19 was given by  WHO  on February 11 2020 to the disease caused by the novel coronavirus SARS-CoV2. The name SARS-CoV2 was given to it because this virus is a genetic cousin of coronavirus which caused the SARS outbreak in 2002 (SARS-CoV)  [1]. What is coronavirus? Coronaviruses are common human and animal  single-strand RNA genome  viruses belonging to the  family coronaviridae  that was first, discover in the 1930S in domestic poultry. In animals,  coronavirus causes a range of respiratory, gastrointestinal, and neurologic diseases.  In human  coronaviruses are mainly seven types that cause a range of diseases. A) Four human  coronaviruses cause symptoms of the common cold namely; 229E, OC43, NL63, and HUK1. B) Three human  coronaviruses cause much more serious lung infections, also called pneumonia. SARS-CoV in 2002  (severe acute respiratory syndrom...
17 comments
Read more