Check List Patient Counseling
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CHECK LIST PATIENT COUNSELING Introduction Greet patient 0 1 2 3 Private/ confidential 0 1 2 3 Identify self 0 1 2 3 State time factor 0 1 2 3 Other 0 1 2 3 Information Gathering Current medication 0 1 2 3 Past medication 0 1 2 3 OTC/ herbs 0 1 2 3 Allergies 0 1 2 3 Signs/ symptoms 0 1 2 3 Lifestyle 0 1 2 3 Other 0 1 2 3 Medication Counseling Name of drug(s) 0 1 2 3 Strength 0 1 2 3 Total dispense/ repeats 0 1 2 3 What medication is for 0 1 2 3 Special instructions 0 1 2 3 Side effects 0 1 2 3 Other 0 1 2 3 Interaction storage Interaction with food 0 1 2 3 Storage 0 1 2 3 Interaction with other drugs 0 1 2 3 Other 0 1 2 3 Conclusion Ask patient to repeat 0 1 2 3 Clarify question 0 1 2 3 Offer to answer question 0 1 2 3
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Transcript of Check List Patient Counseling
CHECK LIST PATIENT COUNSELING
Introduction Greet patient 0 1 2 3Private/ confidential 0 1 2 3Identify self 0 1 2 3State time factor 0 1 2 3Other 0 1 2 3
Information Gathering Current medication 0 1 2 3Past medication 0 1 2 3OTC/ herbs 0 1 2 3Allergies 0 1 2 3Signs/ symptoms 0 1 2 3Lifestyle 0 1 2 3Other 0 1 2 3
Medication CounselingName of drug(s) 0 1 2 3Strength 0 1 2 3Total dispense/ repeats 0 1 2 3What medication is for 0 1 2 3Special instructions 0 1 2 3Side effects 0 1 2 3Other 0 1 2 3
Interaction storage Interaction with food 0 1 2 3Storage 0 1 2 3Interaction with other drugs 0 1 2 3Other 0 1 2 3
ConclusionAsk patient to repeat 0 1 2 3Clarify question 0 1 2 3Offer to answer question 0 1 2 3Other 0 1 2 3
Non VerbalPosture 0 1 2 3Eye contact 0 1 2 3Manner 0 1 2 3Facial expression 0 1 2 3Other 0 1 2 3
Other Other criteria that will help improve counseling 0 1 2 3TOTAL POINT(S):
