Free Prescription Medicine List for Doctors Template
Prescription Medicine List for Doctors
I. Doctor Information
|
Name: |
[YOUR NAME] |
|
License Number: |
12345678 |
|
Contact Number: |
[YOUR EMAIL] |
II. Patient Details
|
Name: |
Jamie Crooks |
|
Patient ID: |
#1234 |
|
Age: |
26 |
III. Prescription Medications
-
Amoxicillin
-
Atorvastatin
-
Metformin
IV. Dosage and Administration
|
Medication Name: |
Metformin |
|
Dosage: |
500 mg |
|
Frequency: |
Twice daily |
|
Administration Method: |
Oral |
V. Additional Notes
Any special instructions or additional notes about the patient's medication:
-
You should follow a balanced diet and exercise regularly to help manage blood sugar levels while on Metformin.
-
Limit your alcohol consumption as it may increase the risk of lactic acidosis.
-
In case of a missed dose, you should take it as soon as they remember, but you should not double the next dose.
VI. Signature
Doctor's Signature:
Date: 09/16/2088
