Patient information | Name |
---|---|
Age | |
Sex | |
Address | |
Outpatient/inpatient | |
Date of prescription Pharmacy code Hospital code | |
Practitioner's information | Qualification |
Duration in practice | |
Information on Diarrhoeal episode | Duration of diarrhoea |
Presence of blood | |
Presence of fever | |
Presence of vomiting | |
Presence of pain in stomach | |
Prescription given | ORS |
Zinc | |
Antibiotics | |
Probiotics | |
Racecadotril | |
Miscellaneous drugs (including antiemetic) |