Pharmacy services provided may include interdisciplinary patient care rounds, medication reconciliation, medication therapy monitoring, medication orders management, medication dispensing, patient education, drug information, drug dosing, and various scholarly activities. Ensure that medication regimen is consistent with all organizational medication use guidelines and policies, or other evidence-based guidelines in the absence of organizational guidelines, which includes (but is not limited to): antimicrobial use, intravenous to oral transition, renal dosing, anticoagulation, and pharmacokinetics/serum drug concentration protocols.