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?. Barnet, Enfield and Haringey
MEDICATION Chart No*. ............ of
Mental Health NHS Trust
IN PATIENT PRESCRIPTION CHART

INSTRUCTIONS FOR USE OF CHART

Notes for Prescriber
1. Write clearly in BLOCK CAPITALS using BLACK
indelible ink
2. Use APPROVED NAME and METRIC UNITS
3. Sign your name with FULL signature and date for
prescription to be valid , ___
20/09/2006

4. Discontinue drugs thus:
and draw a similar line through
recording panels
5. No prescription should be altered. A new prescription
must be written.

6. When all sections have been completed, start a new
prescription chart and file the completed chart in patient's
notes. For Section Patients Only (Please tick if complete)
7. All current prescriptions should be entered on the new
Form T2 Attached □
chart, so that only one chart is in use. Form T3 Attached □
8. Prescriptions are valid for FOUR WEEKS ONLY and
MUST BE REWRITTEN BY A VALID PRESCRIBER.
9. All prescribers circle administration times. Please
Notes for Nursing Staff on Administration
see key below:
1. Check entries in every section to avoid omissions.
2. Patient identity matches prescription chart.
3. A Registered Nurse should initial each administration in the
ADMINISTRATION TIMES
Morn (Morning) 8:00a.m - 9: 30a.m appropriate box.
Lunch (Lunch Time) 12:00p.m - 1: 30p.m 4. In the event of non-administration, record all missed doses
and indicate reasons using the appropriate code:
Eve (Evening) 5:00p.m -6: 30p.m
Night (Night Time) 8:00p.m - 10: 00p.m * Clarify in patient’s note. Codes must be circled
Blank Please state other time Patient away from ward 1

Drug not available* 2
Patient refused drug 3
Drug Omitted* 4
Patient self-medicating 5
Other* 6

ONCE ONLY AND PREMEDICATION DRUGS
DATE DRUG DOSE ROUTE SIGNATURE GIVEN BY TIME PHARM.
PRESCRIBED

83