MEDICACTION PROFILE CARD
Patient Information
NAME: Smith, John O.
PEC: Hypertension, Diabetes
DIAGNOSIS: Pneumonia
SSN: 123-45-6789
AGE: 41yr
WT: 190 lb PRIMARY PHYSICIAN:
CPT
W.T.
SEX: M
Valentine
WARD: 7A BED: 2
ALLERGIES:
SCHEDULED MEDICATIONS
START 1 2 3 4 5 6 7 8 9
DATE
Dimetapp
Po 1 bid
E-mycin 500mg
Po 500mg qid
Dyazide
Po
1 qam
MD0811
2-12