Professional Pharmaceutical Prescription

I. Prescriber's Information

Full Name:	[YOUR NAME]
License Number:	12345678
Contact Number:	222 555 7777
Email Address:	[YOUR EMAIL]
Address:	Dallas, TX 85224

II. Patient Information

Full Name:	Marcelo Green
Date of Birth:	01/01/2050
Contact Number:	222 555 7777
Email Address:	marcelo@you.mail
Address:	Dallas, TX 85224

III. Medication Details

Medication Name:	Amoxicillin
Dosage:	500 mg
Frequency:	Take one capsule every 8 hours.
Route of Administration:	Take one capsule by mouth every 8 hours for 10 days.
Duration:	10 days
Quantity:	30 capsules

IV. Diagnosis

Please provide a brief description of the diagnosis related to this prescription:

• Bacterial Infection

V. Additional Instructions

If there are any specific instructions for this prescription, list them below:

• Take medication with food

• Avoid alcohol during treatment

• Store medication in a cool, dry place

• Other: _____________

VI. Prescriber's Signature

Signature:

Date: 08/11/2082

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Please ensure that all sections are completed before submission. Retain a copy for your records.

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