1. Formal Case Presentation Nora Ahmed, PharmD Student College of Pharmacy-King Saud University PHCL 413: Pharmacy Practice Lab 3 Date

2. Patient Information General Patient Information –Date & time of admission to the hospital or arrival at the clinic or office –Patient initials –Age –Gender –Race –Height –Weight –BMI 2 Don’t get stuck in here, if you don’t have some of the information, that is fine

3. Patient Information CC 3

4. Patient Information HPI 4

5. Patient Information PMH 5

6. Patient Information FH SH Allergies 6

7. Patient Information MedHx Sample Drug RegimenIndicationDurationNotes Digoxin 0.125 mg PO ODCHF1 month Use this column to note specific info drusg mentioned in the case e.g. patient is taking it differently, or if the dose was increased a week ago, or patient stopped 3 days ago…etc Furosemide 80 mg PO BIDCHF4 years 7

8. Patient Information ROS 8

9. Patient Information PE 9

10. Patient Information Lab Tests 10

11. Patient Information Diagnostic Tests 11

12. Medical Problems List 1. 2. 3. 4. 5. 6. 7. 13

13. Topic Discussion Management of XXXXXXXX General approach to the management of main problem Use tables, algorithms, diagrams 1-2 slides maximum 12

14. Drug Related Problems Medical Problem 1 Title 1.DRP 1 2.DRP 2 3.DRP 3 14

15. Drug Related Problems Medical Problem 2 Title 1.DRP 1 2.DRP 2 3.DRP 3 15

16. Drug Related Problems Medical Problem 3 Title 1.DRP 1 2.DRP 2 3.DRP 3 16

17. Medical Problem 1 Title

18. Subjective 3

19. Medical Problem 1 Title Objective 3

20. Medical Problem 1 Title Assessment 3

21. Medical Problem 1 Title Plan 3

22. Medical Problem 2 Title

23. Subjective 3

24. Medical Problem 2 Title Objective 3

25. Medical Problem 2 Title Assessment 3

26. Medical Problem 2 Title Plan 3

27. Medical Problem 3 Title

28. Subjective 3

29. Medical Problem 3 Title Objective 3

30. Medical Problem 3 Title Assessment 3

31. Medical Problem 3 Title Plan 3

32. Summary of the Pharmacist Plan

33. Updated Medication List A list of medications (with dosage regimens) the patient will receive according to your care plan 23

34. References 24