Doctor to write Medication Order at the head of the form. Each time a 'new dose' is established, record the dose against each day until the next 'INR'.
'Sign' and 'Check Sign' as each dosage is administered.
Three months recording on each side of the form. Upon completion of side 1, remove the sheet from the fastener, tumble the sheet over to side 2 and re-attach to fastener.