Free Pediatric Medication List Template
Pediatric Medication List
This Pediatric Medication List is intended for medical management purposes and has been compiled by [YOUR NAME]. It provides essential details about prescribed medications for the child listed below.
Patient Name: Jody Lusk
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Date of Birth: January 15, 2055
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Medical Record Number: 314-8400-371
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Date Compiled: July 3, 2060
Medication Details
Medication Name |
Dosage |
Frequency |
Route |
Special Instructions |
---|---|---|---|---|
Amoxicillin |
250 mg |
Twice daily |
Oral |
Take with food. |
Ventolin (Albuterol) |
2 puffs |
Every 4-6 hours as needed |
Inhalation |
Use spacer device. |
Prednisolone |
5 mg |
Once daily |
Oral |
Take in the morning. |
Zyrtec (Cetirizine) |
5 mg |
Once daily |
Oral |
Take at bedtime. |
Epinephrine (EpiPen) |
0.3 mg |
As needed for emergencies |
Intramuscular |
Administer in case of allergic emergency. |
Fluticasone (Flonase) |
1 spray |
Once daily |
Nasal |
Shake well before use. |
Acetaminophen (Tylenol) |
160 mg |
Every 4-6 hours as needed |
Oral |
Do not exceed 5 doses in 24 hours. |
Ibuprofen (Advil) |
100 mg |
Every 6-8 hours as needed |
Oral |
Take with food. |
Miralax (Polyethylene glycol) |
17 g |
Once daily |
Oral |
Mix with water or juice. |
Ranitidine (Zantac) |
2.5 mL |
Twice daily |
Oral |
Take on an empty stomach. |
Reminders:
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Ensure medications are stored out of reach of children.
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Follow prescribed dosages and timings strictly.
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Contact [YOUR NAME] at [YOUR COMPANY NUMBER] for any medication-related queries.
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Keep this list updated with any changes in the child's medication regimen.
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Emergency responders should be informed of this list in case of emergencies.
Created By: [YOUR NAME]
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Email Address: [YOUR EMAIL]
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Company Name: [YOUR COMPANY NAME]
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Address: [YOUR COMPANY ADDRESS]
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Website: [YOUR COMPANY WEBSITE]
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Social Media: [YOUR COMPANY SOCIAL MEDIA]
This Pediatric Medication List is a vital tool for managing the child's medications effectively.