2005 Edition Report on Drug Administration Procedure & Practices ...

Hospital Authority Hospital No. : ID No. :Hospital Name : ( )Intravenous Fluid And Drug Additive Administration Form Date of Birth : Age/Sex :All IV infusions must be written by the prescribers and reviewed on a daily basis Ward : Bed No. : Dept :Known Drug Sensitivity/Allergy :Weight : Kg Height :Diagnosis :IV Fluid Prescription Record of AdministrationLine C/P Date/time IV fluid Volume Drug Additives Infusion rate Dr. sign. TimestartGivenbyCheckedbyVolume infusedPharmacy useC = central P = peripheralHAHO Aug 001