Physician order form to ensure reconciliation of medications at the time initial orders are written used at Missouri Baptist Medical Center in St. Louis, Missouri, USA. The form is designed so that staff can document a patient’s home medications directly on the form and the ordering physician need only indicate whether each one should be continued, and add any additional medication orders needed.

Use this order form as a template for creating a similar form in your own organization to allow for easy reconciliation of medications on admission.

Related Measures
Errors from Unreconciled Medications per 100 Admissions

Related Changes
Reconcile Medications at All Transition Points
Reconcile Admission Orders with Home Medication Lists