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Acetaminophen (160 mg/5 mL)
Amount given
Time
Date
Acetaminophen 325 mg tablets
Amount
• • •
Time
Date
Acetaminophen 500 mg tablets
Amount
• • •
Date
Time
Acetaminophen 80 mg suppository
Amount
• • •
Date
Time
Ibuprofen 200 mg tablets
Amount
• • •
Date
Time
Ibuprofen (100 mg/5 mL)
Amount given
Date
Time
Benadryl 25 mg capsules
Amount
• • •
Date
Time
Benadryl liquid 12.5 mg/5 mL
Amount given
Date
Time
Odansetron/Zofran 4mg Disintegrating Tablets
Amount
• • •
Date
Time
Dexamethasone Tablets 4 mg
Amount
• • •
Date
Time
Cephalexin (250 mg/5 mL)
Amount given
Date
Time
Amoxicillin (400 mg/5 mL)
Amount given
Date
Time
Pedialax Liquid Glycerin 4 mL
Amount given
Date
Time
Pedialax glycerin suppository
Amount
• • •
Date
Time
Albuterol Nebulizer (2.5 mg/3 mL)
Amount
• • •
Date
Time
Albuterol 3 mg/Atrovent 0.5 mg
Amount
• • •
Date
Time
Recepinephrine 2.25% (0.5 mL)
Amount
• • •
Date
Time
Silver Nitrate Applicator
Amount Used
• • •
Location used
Date
Time

Medications Administered Medical Form

Urgent Care

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Published: July 9, 2021, 5:22 p.m.
Doctor: Dr. History Physical
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