| PATIENT NAME | ROOM NUMBER | ||
The following medication has been ordered: |
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(drug name, dose, and frequency ordered) |
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Based on the Cockroft and Gault Equation and a serum creatinine of drawn on , the estimated creatinine clearance is ml/min. Based on the above Crcl, it is recommended that the dose of be changed to: |
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(recommended dose and frequency) |
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Pharmacist's Name |
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