<p> Dietary Supplement Labeling Exemption Sample Staff Training Quiz</p><p>Directions: </p><p> Circle the strength of the Dietary Supplement on the manufacturer’s label. </p><p> Based upon the Health Care Provider (HCP) order, document the amount that you would administer.</p><p> Transcribe the Health Care Provider order onto the Medication Administration Record.</p><p>************************************************************************************************************</p><p>1. HCP order: Ginkgo Biloba 180 mg every morning with breakfast by mouth. Reason: Dietary Supplement</p><p>Amount: ______</p><p>2. HCP order: Ginkgo Biloba 60 mg every evening by mouth. Reason: Dietary Supplement</p><p>Amount: ______3. HCP Order: St. John’s Wort 1400 mg twice a day (with breakfast and supper) by mouth. Reason: Dietary Supplement</p><p>Amount: ______</p><p>4. HCP Order: Vitamin C 1500 mg twice a day by mouth. Reason: Dietary Supplement</p><p>Amount: ______5. HCP Order: Vitamin E 2000 IU daily at bedtime by mouth. Reason: Dietary Supplement</p><p>Amount: ______</p><p>6. HCP Order: Ascorbic Acid 2000 mg every morning by mouth. Reason: Dietary Supplement</p><p>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</p><p>Stop</p><p>Special Instructions:</p><p>Reason for Med:</p><p>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</p><p>Stop</p><p>Special Instructions:</p><p>Reason for Med:</p><p>Init Signature Signature Name: </p><p>HCP: Program:</p><p>Accuracy Check 1 ______Date______Time______Accuracy Check 2 ______Date______Time______Version 7.0 Page __ of __ Pages</p>