Dental Clinic Prescription
[YOUR COMPANY NAME]
Date: October 8, 2055
Prescription No.: DC-2055-00123
I. Patient Information
Field | Details |
|---|
Patient Name | Cyrus Ortiz |
Age | 42 |
Gender | Male |
Contact Information | 222 555 7777 |
II. Prescription Details
Field | Description |
|---|
Diagnosis | Tooth abscess |
Prescription Type | Antibiotics, Pain relief |
Medication Name | Amoxicillin 500 mg / Ibuprofen 400 mg |
Dosage | 1 tablet every 8 hours for 7 days |
Route of Administration | Oral |
Duration | 7 Days |
Special Instructions | Take medication with food, avoid alcohol |
Next Appointment | October 15, 2055 |
III. Medications
Medication | Dosage | Frequency | Duration |
|---|
Amoxicillin 500 mg | 1 tablet | Every 8 hours | 7 days |
Ibuprofen 400 mg | 1 tablet | As needed for pain relief | As needed |
IV. Additional Instructions
Complete the full course of antibiotics even if you feel better before finishing them.
Do not consume alcohol while taking antibiotics.
Use a soft-bristled toothbrush to avoid irritation of gums.
Rinse with antiseptic mouthwash twice daily.
V. Doctor's Information
Field | Details |
|---|
Doctor's Name | [YOUR NAME], DDS |
License No. | 9876543210 |
Contact Information | [YOUR EMAIL] |
VI. Signature
Signature:
Date: October 8, 2055
Prescription Templates @ Template.net
