Site Map	Complete an Inpatient Prescription Form

• All writing must be legible and in ink
• Fill in patient details including (stickers acceptable)
  • Patient's name
  • Date of birth
  • Hospital ID
  • Address
  • Location in hospital (ward)
• Fill in details of consultant (including hospital code if appropriate)
• Identify and list known allergies
• Regular medication
  • Date of entry
  • Generic name of drug
  • Dose
  • Route of administration
  • Frequency and time of administration
  • Duration of course
  • Signature
• As required medication
  • Date of entry
  • Generic name of drug
  • Dose
  • Route of administration
  • Maximum frequency of adminstration
  • Signature
• Intravenous fluids
  • Date of entry
  • Name and description of fluid
  • Volume of fluid
  • Rate of administration
  • Duration of course
  • Signature
• Oxygen administration
  • Date of entry
  • Percentage concentration of oxygen
  • Route
  • Rate of delivery
  • Signature

	Any comments or feedback please contact me by email: Tom Williams