Doctor's Medication Order Template for Campers
ABCDE CAMP
3203 Pennsylvania Avenue, Newark, NJ, 07102
(123) 1234567 - info@abcdecamp.com
3203 Pennsylvania Avenue, Newark, NJ, 07102
Phone: (123) 1234567 - Fax: (123) 1234567
Web: www.abcdecamp.com
Email: info@abcdecamp.com
| Yes/No | Description/Remarks | |
|---|---|---|
| Does the camper have any known allergies? If yes, then please specify in the Description field. | Yes | Allergic to seafoods |
| Is he/she currently taking any medications? If yes, then please list the medications and the reasons why the camper are taking them. | Yes | Vitamin C |
| What is the current medical condition of the camper? Does he have any communicable disease, cardiovascular problems, diabetes, asthma, etc.? | No | |
| Was the camper ever been hospitalized? If yes, please indicate why and when. | No | |
| Did the camper undergo any previous surgery? If yes, please indicate the procedure name, reason, and the date. | No | |
| Learning disabilities | No | |
| Emotional or behavioral problems | No | |
| Is the immunization up to date? | Yes |
- Acetaminophen
- Antacids
- Anti-Histamine
3203 Pennsylvania Avenue, Newark, NJ, 07102
Phone: (123) 1234567 - Fax: (123) 1234567
Web: www.abcdecamp.com
Email: info@abcdecamp.com
| Medication Name | Schedule | Dosage | Route | Reason/Purpose | |
|---|---|---|---|---|---|
| 1 | Tempra | Every 4 hours | 7ml | Oral | Cure fever |
| 2 | Amoxicillin | Every 8 hours | 5ml | Oral | Anti-biotic |
| 3 | Sinecod Forte | As needed | 2ml | Oral | Suppress cough |
| 4 | Mucolytic | Every 6 hours | 4ml | Oral | Liquify phlegm |
| 5 | Celeen | Every morning | 1 tablet | Oral | Vitamin C |
| 6 | |||||
| 7 | |||||
| 8 | |||||
| 9 | |||||
| 10 |
Note: All doctor's prescription order should be given to the health care team.
3203 Pennsylvania Avenue, Newark, NJ, 07102
Phone: (123) 1234567 - Fax: (123) 1234567
Web: www.abcdecamp.com
Email: info@abcdecamp.com
A Doctor's Medication Order Template for Campers is proof that the medicines taken by the camper are ordered by the doctor. A good medication order document should contain information about the medicine and the reason why it is being taken. It is also critical to provide accurate data on how it will be administered because this is where the health care team will be referencing to.
This awesome Doctor's Medication Order Template for Campers contains information about the camper, the parent/guardian details, current medical data, and the medications ordered by the doctor. The template is also using the E-signature widget to capture the digital signature of the physician who ordered the medications. The Medication Order table shows that name of the medicine, schedule on when will it be administered, dosage amount, how it will be administered, and the reason why the camper is taking that medicine. The Current Data and Medical History section use the Input Table's multiple type columns option. This allows the template to have a dropdown and a textbox field in the same row.
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