Free Simple Prescription Note Template
Simple Prescription Note
Patient Information:
Name: Macey Erdman
Date of Birth: January 1, 2050
Address: Peoria, AZ 85345
Doctor's Note:
Date: October 8, 2055
To Whom It May Concern:
I, Dr. [YOUR NAME], am a licensed medical practitioner. This note serves as a prescription for the following medication for my patient, Macey Erdman.
Prescription Details:
Medication: Amoxicillin
Dosage: 500 mg
Frequency: Take one capsule orally three times a day
Duration: 7 days
Indication for Prescription:
To treat a bacterial infection as diagnosed during the patient's recent consultation.
Additional Instructions:
-
Complete the full course of medication, even if symptoms improve before finishing the prescription.
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Drink plenty of fluids and avoid alcohol while on this medication.
Physician Information:
Name: Dr. [YOUR NAME]
License Number: 123456789
Contact Information: [YOUR EMAIL]
