Home Medication Assessment Physician Order Form - csks lexmednetwork 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the KNOWN ALLERGY & REACTION section. Indicate any allergies by checking 'Yes' or 'No' for each listed item, including Betadine/Iodine, Latex, IVP Dye/CT Prep, and any other contrast agents.
3. In the ADMISSION: Home Medication Assessment section, specify if the patient takes no medications or herbals. If applicable, include herbal/OTC/vitamins as noted.
4. For IN HOSPITAL/HEALTH CARE SETTING, check which medications should be continued. Fill in the name and strength of each medication along with dosage and route of administration.
5. Complete the Home Medications Disposition section by selecting where information was obtained from and noting if medications were brought in or transferred with the patient.
6. Finally, ensure that all signatures are completed in the acknowledgment sections for both physician and clinical staff.

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