💊 IP Prescription — Medication Chart
Form No. 4 • SKS Hospital & Postgraduate Medical Institute
Baby Name
UHID
Visit / IP No
Date of Birth
Gender
Weight (g)
Ward
Consultant
Sheet No
⚠️ Drug Allergies
📋 Regular Prescriptions
Scheduled Medications
💉 Once Only & Premedication Drugs
Single Dose
| S.No | Date | Drug (Pharmacological) | Brand Name | Dose mg | Dose mL | Time | Route | Signature | Status |
|---|
🔔 As Required (PRN) Drugs
When Needed
💧 Intravenous Infusion Therapy
IV Fluids & Blood Products