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    Name of Pharmacy: ................................. City

    Uploaded by

    ravi sheladiya
    This document contains the required elements of a prescription form, including the doctor's name, qualifications, registration number, address and contact details. It also includes fields for the patient's name, age, sex, weight, and the prescribed medications, including name, strength, dosage instructions, duration and quantity. The bottom of the form is for the dispensing pharmacist to sign and include the dispense date and pharmacy details.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Name of Pharmacy: ................................. City

    Uploaded by

    ravi sheladiya
    31 views1 page
    This document contains the required elements of a prescription form, including the doctor's name, qualifications, registration number, address and contact details. It also includes fields for the patient's name, age, sex, weight, and the prescribed medications, including name, strength, dosage instructions, duration and quantity. The bottom of the form is for the dispensing pharmacist to sign and include the dispense date and pharmacy details.

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    form

    Original Title

    40225000_MBBS

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    This document contains the required elements of a prescription form, including the doctor's name, qualifications, registration number, address and contact details. It also includes fields for the patient's name, age, sex, weight, and the prescribed medications, including name, strength, dosage instructions, duration and quantity. The bottom of the form is for the dispensing pharmacist to sign and include the dispense date and pharmacy details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views1 page

    Name of Pharmacy: ................................. City

    Uploaded by

    ravi sheladiya
    This document contains the required elements of a prescription form, including the doctor's name, qualifications, registration number, address and contact details. It also includes fields for the patient's name, age, sex, weight, and the prescribed medications, including name, strength, dosage instructions, duration and quantity. The bottom of the form is for the dispensing pharmacist to sign and include the dispense date and pharmacy details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Doctor's Name

    Qualification (eg.MBBS, MD)

    Regn. No •

    Full Address, Contacts: (telephone No. E-mail etc.)

    Date:

    Name of the Patient ...........................................................................................

    Address* ................................................................................................................................

    Age & Sex ................................ weight**

    Rx

    1) Name of Medicine***

    Strength, dosage instruction, duration & total quantity ***

    2) - do -
    3) - d o -

    Doctor's signature
    Stamp
    DISPENSED

    Date: .................... Pharmacist -

    Name of Pharmacy: .................................


    City

    *Postal address/E-mail/Mobile

    Number **for Paediatric Patients ***

    in capital letters only

    Minimum size of the prescription blank should be (a) 14 X 21 cm (AS size) & (b) XI x XI cm size.

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