PATIENT MEDICATION PROFILE
Name: LETTY T. CHAMOS Sex: FEMALE Physician: DR. JULIE C. COBATO Phone: NONE
Address: #97 UPPER SAN CARLOS HEIGHTS, IRISAN Address: CABATO CLINIC, MAGSAYSAY
BAGUIO CITY
City: BAGUIO CITY Zip: 2600 Age: 47 Birthdate: 02/26/1972 Physician: Phone:
Emergency Contact: 09500602811 Pharmacy: Phone:
Height: 5’2” Weight: 53kg Phone: Pharmacy: Phone:
Drug Allergies: NONE
MEDICAL INFORMATION
DATE MEDICATION DOSAGE COMMENTS DATE MEDICATION DOSAGE COMMENTS
STRENGTH STRENGTH
2013 Losartan 100mg tablet For 2018 Furosemide 10 mg tablet The medicine
maintenance was
Signa: Take Signa: Take one prescribed
one tablet tablet once a day when her right
once a day leg bulged
The medicine
was
discontinued
last October
2018
2013 Deltiazem 60 mg tablet The medicine April 2018 Poten- Cee + 1 Capsule For food
was Prescribed Vitamin C supplment
Signa: Take a month after Signa: Take one
two tablets Losartan was capsule once a a
once a day given for day
maintenance.
*REMEMBER TO UPDATE YOUR MEDICATIONS – Mark out medications that are discontinued. Add new medications started.
SAINT LOUIS UNIVERSITY, BAGUIO CITY
_____________________________________________ _______________________ ____________________________________________
PATIENT/GUARDIAN’S SIGNATURE DATE SIGNATURE OF THE PHARMACIST