Prescription Medicine List
Patient Information
Patient Name: Houston Smith
Date of Birth: January 15, 2050
Patient ID: 123456
Contact Information: 222 555 7777
Date of Prescription: October 8, 2084
Prescriber Information
Prescriber Name: Dr. [YOUR NAME]
Prescriber’s Address: [YOUR COMPANY ADDRESS]
Prescriber’s Contact Information: [YOUR EMAIL]
License Number: CA-789456
Medication Details
Medication Name | Dosage | Frequency | Route of Administration | Indications | Refills |
|---|
Amoxicillin | 500 mg | 3 times a day | Oral | Bacterial infections | 2 |
Metformin | 500 mg | Twice a day | Oral | Type 2 diabetes | 3 |
Lisinopril | 20 mg | Once daily | Oral | Hypertension | 0 |
Atorvastatin | 10 mg | Once daily | Oral | Hyperlipidemia | 1 |
Albuterol Inhaler | 90 mcg | As needed | Inhalation | Asthma or COPD exacerbation | 3 |
Additional Instructions
Amoxicillin: Take with food to minimize gastrointestinal upset. Complete the full course even if symptoms improve.
Metformin: Take with meals to reduce the risk of gastrointestinal side effects.
Lisinopril: Monitor blood pressure regularly and report any significant changes.
Atorvastatin: Advise a heart-healthy diet alongside medication for optimal results.
Albuterol Inhaler: Shake well before use. Use 2 puffs as needed for shortness of breath.
Patient Notes
Follow-Up Appointment
Prescriber Signature:
Date: October 8, 2055
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