EFTA00059449

Medication Administration Record

<table><tr><td>76318-054</td><td>EPSTEIN, JEFFREY</td></tr></table>

<table border="1"><tr><td colspan="2">Medication Orders</td><td>Time</td><td>1</td><td>2</td><td>3</td><td>4</td><td>5</td><td>6</td><td>7</td><td>8</td><td>9</td><td>10</td><td>11</td><td>12</td><td>13</td><td>14</td><td>15</td><td>16</td><td>17</td><td>18</td><td>19</td><td>20</td><td>21</td><td>22</td><td>23</td><td>24</td><td>25</td><td>26</td><td>27</td><td>28</td><td>29</td><td>30</td><td>31</td></tr><tr><td rowspan="5">Cst. Date07/30/1914:21Exp. Date07/31/1910:01NYM122148-NYM</td><td rowspan="5">Inject regular Insulin subcutaneously per sliding scale: twice daily***pill line** for 7 daysInsulin Reg (10 mL) 100 UNITS/SML inj</td><td>MD</td><td>PRN</td><td></td><td>





EFTA00059450


<table><thead><tr><th rowspan="2">Medication Orders</th><th colspan="30">Medication Administration Record</th></tr><tr><th>Time</th><th>1</th><th>2</th><th>3</th><th>4</th><th>5</th><th>6</th><th>7</th><th>8</th><th>9</th><th>10</th><th>11</th><th>12</th><th>13</th><th>14</th><th>15</th><th>16</th><th>17</th><th>18</th><th>19</th><th>20</th><th>21</th><th>22</th><th>23</th><th>24</th><th>25</th><th>26</th><th>27</th><th>28</th><th>29</th><th>30</th><th>31</th></tr></thead><tbody><tr><td>Ord. Date<br>07/31/19<br>10:00</td><td rowspan="4">MD<br>Inject regular insulin subcutaneously per sliding scale; each morning for 7 days ***pill**<br>08/07/19<br>09:59</td><td>PRN</td><td></td><td>

Providers: YJ = Documentation Codes: ORD = Order | NI = Dose Not Indicated

Registration #: 76318-054 PT. Name: EPSTEIN, JEFFREY

DOB: 01/20/53
Report information is current as of the date and time of printing: 08/10/2019 11:02 EST