Medication Reconciliation Form Mrs. Elizabeth Anderson was brought into the ER this afternoon after an episode of hypoglycemia where she was dizzy, sweating, and lost consciousness. She tells you is diabetic, has high blood pressure and says she doesn’t have any drug allergies. She is 5’3″ and weighs 182 lbs, her birthday is 1/15/32, and she tells you the medications she is taking. She takes all of her medications that are ordered daily in the morning, and she took all of her morning doses at 8 AM. Mrs. Anderson ate dinner at 6 PM last evening, and she remembered to take the simvastatin at that time. glyburide 5mg 2x day aspirin EC 325mg daily metformin 500mg twice a day lisinopril 10mg in the morning hydrochlorothiazide 25mg in the morning simvastatin 20mg in the evening with dinner Synthroid 100mcg every morning Mr. Richard Wilson was admitted to the hospital late this morning after having a cough and a fever for 3 days. A chest X-ray show that he has pneumonia and you are sent to verify the medication he takes at home. His daughter says his birthday is 9/9/23 he is 5’10”, 177lbs and is allergic to penicillin and gives you the list below. He takes all medications listed as daily in the morning, and he took all morning doses at 8 AM. Mr. Wilson also remembered to take his medication at dinner and bedtime last night. He ate dinner at 6 PM and went to bed at 8PM. furosemide 20mg in the morning enalapril 20mg daily digoxin 0.25mg daily warfarin 1mg at bedtime Lipitor 20mg with dinner Mr. Wilson’s daughter said the rest of his medications are filled at the local pharmacy and she isn’t sure what they are and asks you to call. The medications were taken at the correct times. Tylenol #3 was taken at 9AM this morning. When you call, you are given the following: Aricept 10mg at bedtime Namenda 10mg every morning and at bedtime omeprazole 20mg in the morning Tylenol #3 1 or 2 every 4 to 6 hours as needed Remember to use your abbreviations when filling out your reconciliation document. For example, if the patient says that they take their tablet in the morning, use “po” for the route and “qam” for the frequency.
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