Dietary Supplement Labeling Exemption

Dietary Supplement Labeling Exemption Sample Staff Training Quiz

Directions:

 Circle the strength of the Dietary Supplement on the manufacturer’s label.

 Based upon the Health Care Provider (HCP) order, document the amount that you would administer.

 Transcribe the Health Care Provider order onto the Medication Administration Record.

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1. HCP order: Ginkgo Biloba 180 mg every morning with breakfast by mouth. Reason: Dietary Supplement

Amount: ______

2. HCP order: Ginkgo Biloba 60 mg every evening by mouth. Reason: Dietary Supplement

Amount: ______3. HCP Order: St. John’s Wort 1400 mg twice a day (with breakfast and supper) by mouth. Reason: Dietary Supplement

Amount: ______

4. HCP Order: Vitamin C 1500 mg twice a day by mouth. Reason: Dietary Supplement

Amount: ______5. HCP Order: Vitamin E 2000 IU daily at bedtime by mouth. Reason: Dietary Supplement

Amount: ______

6. HCP Order: Ascorbic Acid 2000 mg every morning by mouth. Reason: Dietary Supplement

Amount: ______Start Hour 1 3 4 6 7 9 10 12 13 15 16 18 19 21 22 24 25 27 28 2 30 31 9

Special Instructions:

Reason for Med:

Start Hour 1 3 4 6 7 9 10 12 13 15 16 18 19 21 22 24 25 27 28 2 30 31 9

Special Instructions:

Reason for Med:

Init Signature Signature Name:

HCP: Program:

Accuracy Check 1 ______Date______Time______Accuracy Check 2 ______Date______Time______Version 7.0 Page __ of __ Pages