Medication Order Entry
Precision Psychiatric Services
Patient Name
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Provider Name:
*
Please Select
Mandeep Bagga, MD
Matthew Bryan, MD
Abdolreza Saadabadi, MD
Eehai Mcarty
Suresh Babu Kurra, MD
Sukhjit Brar, MD
Rahi Daneshvar, MD
Arul Sangani, MD
Rama Yasaei, MD
What would you like to do?
*
Discontinue Medication
Change Current Medication Order
Add New Medication
Other
Number of New Medications being ordered:
1
2
3
4
Medication 1
Medication 1 Dose:
Medication 1 Frequency:
Please Select
QAM (Daily)
BID
QHS
TID
QID
Medication 2
Medication 2 Dose:
Medication 2 Frequency:
Please Select
QAM (Daily)
BID
QHS
TID
QID
Medication 3
Medication 3 Dose:
Medication 3 Frequency:
Please Select
QAM (Daily)
BID
QHS
TID
QID
Medication 4
Medication 4 Dose:
Medication 4 Frequency:
Please Select
QAM (Daily)
BID
QHS
TID
QID
Change order (ie Increase Zyprexa from 5mg BID to 10mg BID)
Discontinue order (ie DC Haldol 5mg BID)
Provider Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: